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DENTAL  MATERIA  MEDICA, 
THERAPEUTICS 

AND 

PEESCMPTION  WRITING. 


BY 


ELI    H.    LONG,    M.D., 

PEOFESSOE  OP  DENTAL  MATEEIA  MEDICA  AND  THEEAPEUTICS  IN  THE  DENTAL  DEPAETMENT, 

UNIVEESITY  OF  BUFFALO  ;   PROFESSOR  OF  MATERIA  MEDICA  AND  THERAPEUTICS  IN 

THE  MEDICAL  DEPARTMENT,  UNIVERSITY  OF  BUFFALO; 

ASSISTANT  ATTENDING  PHYSICIAN  TO  THE  BUFFALO  GENERAL  HOSPITAL. 


THIRD    EDITION,   REVISED   AND   ENLARGED. 


ILLUSTRATED  WITH  SIX    ENGRAVINGS   AND    EIGHTEEN 
COLORED  DIAGRAMS. 


LEA  &  FEBIGER, 

PHILADELPHIA    AND    NEW   YOEK, 
1909. 


<^  ^  ♦-f ,. 


5\ 


t^i 


Copyright,  1909,  by 
LEA  &  FEBIGER. 


Authority  to  use  for  comment  the  Pharmacopoeia  of  the  United  States 
of  America  (Eighth  Decennial  Revision),  in  this  volume,  has  been  granted 
by  the  Board  of  Trustees  of  the  United  States  Pharmacopceial  Convention; 
which  Board  of  Trustees  is  in  no  way  responsible  for  the  accuracy  of  any 
translations  of  the  OfiBcial  Weights  and  Measures,  or  for  any  statement  as 
to  strength  of  Official  Preparations. 


DORNAN,    PRINTER, 
PHILADELPHIA. 


TO 


THE   MEMORY    OF 

WILLIAM   T.  G.  MORTON,    M.  D., 

WHO    FIRST 
MADE    KNOWN    SURGICAL  ANESTHESIA   BY 

ETHER, 

AND    TO    WHOM   THE      ' 

PROFESSIONS   OF  MEDICINE    AND   DENTISTRY,   AND   THE   WORLD,   OWE 
\ 

A    DEBT   OF    PERPETUAL    GRATITUDE, 

THIS   VOLUME 

IS   DEDICATED. 


Digitized  by  tine  Internet  Arciiive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/dentalmateriamed1909long 


PREFACE  TO  THE  THIRD  EDITION. 


The  opportunity  presented  by  the  demand  for  a  new  edition  has  been 
utilized  to  effect  a  thorough  revision  to  date  without  changing  the  essen- 
tial features  of  a  work  which  appears  to  have  met  with  approval.  The 
author's  original  purpose  was  to  select  from  the  vast  body  of  knowledge 
comprised  in  Materia  Medica  and  Therapeutics  such  portions  as  were 
essential  for  students  of  dentistry,  and  to  supply  also  in  concise  form 
what  is  necessary  for  them  to  know  of  pharmacology  as  related  to  the 
most  important  drugs  of  general  effect.  IMany  years  of  experience  in 
teaching  had  developed  definite  ideas  as  to  the  requirements  of  such  a 
course,  differing  greatly  as  it  does  from  the  corresponding  element  in 
the  medical  curriculum. 

In  this  revision,  aside  from  the  enlargement  or  abridgment  of  certain 
topics,  some  decided  changes  will  be  found  in  several  chapters.  Under 
"Antiseptics"  more  attention  is  devoted  to  the  volatile  oils  in  regard  to 
their  definite  characters,  their  action  and  their  comparative  values,  and 
among  miscellaneous  drugs  of  this  class  recent  observations  as  to  potency 
are  given.  Among  "Local  Analgesics"  the  newer  agents  receive  such 
attention  as  present  knowledge  warrants.  The  chapter  on  "General 
Anaesthetics"  has  required  considerable  change,  the  discussion  of  ethyl 
chloride  especially  calling  for  amplification  in  general,  and  recognition 
of  its  dangers.  In  a  new  chapter  on  "Dentistry  during  Pregnancy,"  the 
care  of  the  teeth  and  operative  treatment  during  gestation  are  discussed 
in  relation  to  prophylaxis. 

The  chapter  on  "Prescription  Writing"  is  intended  to  answer  practi- 
cal requirements,  and  to  aid  in  correcting  the  proprietary  formula  abuse, 
which  is  antagonistic  to  scientific  therapeutics.  Few  formulas  are  given 
in  the  book,  and  these  are  intended  to  be  suggestive.  This  chapter  is 
planned  to  aid  the  student  to  rise  above  dependence  upon  ready-made 
formulas,  and  to  qualify  him  for  the  greater  success  which  can  be  achieved 
by  adapting  his  treatment  to  the  case  before  him.  This  power  is  attain- 
able through  a  thorough  knowledge  of  drugs  and  their  chemical  and 
pharmacological  c[ualities. 

(v) 


vi  PREFACE  TO   THE  THIRD  EDITION 

The  arrangement  of  remedies  Into  groups,  based  on  their  action  and 
uses,  has  been  retained,  as  it  aids  the  student  in  acquiring  what  is  so  im- 
portant, a  comparative  knowledge  of  drugs  and  their  properties. 

While  new  remedies  of  value  are  duly  recognized,  little  attention  is 
given  to  those  which  are  yet  untried.  Every  year  sees  a  vast  number 
of  these  put  out  and  recommended  for  commercial  ends.  The  very  few 
that  are  valuable  survive.  A  book  which  aims  to  cover  its  subject  con- 
cisely, scientifically,  and  practically  must  include  the  latest  approved 
facts  and  exclude  matters  which  have  not  reached  that  level. 

E.  H.  L. 


CONTENTS. 


PART  I. 


PAGE 

INTRODUCTION 17 


CHAPTER  I. 

Drugs  and  Medicines:   Their  Constituents  and  Preparations         ...       21 

CHAPTER  II. 

Remedies:  Their  Classification  and  Definitions    ......       38 

CHAPTER  III. 

^      Administration  of  Medicines     .........       42 

CHAPTER  IV. 

Modes  of  Action  of  Medicines  ......  i  ..       51 


PART  II. 

LOCAL  REMEDIES. 

CHAPTER  V. 

Depletives       .         .         .  .  .  .         .         .         .         .55 

CHAPTER  VI. 

Counterirritants       ...........       69 

(  vii  ) 


viii  CONTENTS 

CHAPTER  VII. 

PAGE 

Escharotics     .............       70 

CHAPTER  VIII. 

Demulcents  and  Emollients      .........       90 

CHAPTER  IX. 

Astringents  and  Hemostatics   .........       94 

CHAPTER  X. 

Detergents,  Antacids  and  Alkalies    ........     112 

CHAPTER  XI. 

Antiseptics      ............     120 

CHAPTER  XII. 

Bleaching  Agents    .  .  .  .  .  .  .  .  .  .  .     150 

CHAPTER  XIII. 

Anesthetics.     Local  Analgesics  ....  .  .         .  .  .     155 


PART  III. 

GENERAL   REMEDIES. 

CHAPTER  XIV. 

Anesthetics       . 173 

CHAPTER  XV. 

Stimulants 195 

Tonics 204 

CHAPTER  XVI. 

Alteratives 211 

Syphilis  and  its  Treatment.      .         .  ........    213 


CONTENTS  IX 


CHAPTER   XVII. 

PAGE 

Sedatives 217 

First  Dentition  Complications  and  tiieir  Treatment 220 


CHAPTER    XVIIL 

Eliminatives ^ 228 

CHAPTER  XIX. 

Dentistry  during  Pregnancy ■       •     233 


PART  IV. 

CHAPTER  XX. 

Prescription  Writing 237 

Abbreviated  Terms  in  Common  Use  in  Prescriptions 259 

CHAPTER   XXI. 

Poisons 260 

Table  of  Poisons  and  Antidotes 262 

Index  of  Drugs 269 

\    General  Index ^^^ 


DENTAL  MATERIA  MEDICA,  THERAPEUTICS,  AND 
PRESCRIPTION  WRITING. 


PARTI. 
INTRODUCTION. 


The  need  of  a  book  on  Materia  Medica  and  Therapeutics,  prepared 
especially  for  the  specialist  in  dentistry,  indicates  a  certain  distinctness 
of  practice  that  does  not  apply  to  other  specialties.  The  general  text- 
book on  this  branch  is  all  that  is  wanted  by  the  general  surgeon,  the 
ophthalmologist,  the  gynecologist,  and  in  fact  by  all  specialists  whose 
preparation  includes  a  complete  medical  course  of  study.  AVhether  we 
regard  the  condition  as  normal  or  not,  the  fact  is  apparent  that  the  prac- 
tice of  dentistry  today  has  little  in  common  with  general  medicine. 
This  is  likely  to  be  true  to  a  degree  for  the  future  also,  even  though  the 
tendency  must  be  to  broaden  the  curriculum  of  dental  colleges,  ^\h\\e 
there  is  evidence  that  the  broadening  process  is  going  on,  one  special 
direction  in  which  a  more  general  knowledge  is  demanded  is  in  diseases 
of  the  circulation,  in  view  of  the  frequent  use  of  general  anaesthetics  by 
the  dental  surgeon.  A  clinical  course  in  physical  diagnosis,  sufficient 
to  enable  the  student  to  detect  diseases  of  the  heart,  lungs  and  blood- 
vessels, is  a  needed  addition  to  the  course  of  study.  The  preparation 
for  special  practice  cannot  be  too  broad  as  to  principles,  but,  at  the  same 
time,  there  is  a  practical  limit  to  the  detail  of  general  medicine  that  can 
profitably  enter  into  the  dental  student's  undergraduate  work. 

The  matter  entering  into  these  chapters  is  written  from  a  standpoint 
that  recognizes  the  need  of  a  special  text-book,  but  that  also  realizes  the 
"narrowing  tendency  that  inevitably  attends  the  supplying  of  that  need. 
The  author,  therefore,  makes  no  apology  for  attempting  to  illustrate  by 
diagrams,  with  brief  explanatory  text,  the  action  of  the  most  important 

2  (17) 


18  DENTAL  MATERIA   MEDIC  A 

internal  drugs  upon  the  general  system,  nor  for  the  somewhat  extensive 
treatment  of  classes  of  remedies  and  preparation  of  drugs. 

Certain  general  terms  require  definition  or  comment  at  the  outset. 

Materia  medica,  in  a  restricted  sense,  means  the  materials  or  substances 
used  in  medicine.  In  a  broad  sense,  the  term  means  the  science  that 
treats  of  drugs  in  their  varied  relations. 

Pharmacy  is  the  science  of  preparing  medicines  for  use.  It  includes 
not  only  the  making  of  drug  preparations,  but  also  the  art  of  compound- 
ing and  dispensing  medicines. 

Pharmacology  has  had  much  the  same  meaning  as  materia  medica  in 
its  broad  sense,  but  it  has  more  recently  come  to  be  applied  to  a  distinct 
part  of  the  science  of  drugs,  that  which  treats  of  the  action  of  drugs  upon 
the  tissues,  organs  and  functions  of  the  body. 

Therapeutics  is  the  science  and  art  of  employing  remedies  in  the  treat- 
ment of  disease.  While  therapeutics  should  have  a  scientific  basis  in 
the  knowledge  of  the  action  and  effects  of  remedies,  practical  treatment 
of  disease  will  always  remain  an  art,  because  of  the  many  modifying 
factors  that  render  scientific  precision  impossible. 

Toxicology  is  that  part  of  medical  science  which  treats  of  poisons. 
It  includes  the  action  and  effects  of  poisons,  their  detection,  and  the 
treatment  of  the  conditions  resulting  from  poisoning. 

As  a  standard  for  the  purity  and  uniformity  of  drugs  and  prepara- 
tions, we  have  the  volume  known  as  the  United  States  Pharmacopoeia, 
which  is  the  recognized  authority  for  this  country.  Other  countries  have 
similar  standards.  The  book  does  not  treat  of  the  action  or  uses  of 
medicines,  but,  as  its  main  object,  it  furnishes  a  hst  of  recognized  drugs, 
with  descriptions,  tests  of  purity,  etc.,  and  of  preparations,  with  their 
formulas.  The  drugs  and  preparations  thus  recognized  are  called  official. 
The  book  not  only  is  the  authority  upon  drugs  and  their  preparations, 
but  it  forms  the  basis  of  our  text-books  on  materia  medica,  pharmacy 
and  therapeutics.  The  revision  of  1900  for  the  first  time  contains  also 
doses  of  official  drugs  and  preparations.  The  abbreviation  (U.  S.  P.) 
always  indicates  this  work. 

A  dispensatory  is  a  comprehensive  text-book  on  materia  medica.  It 
has  been  called  a  commentary  upon  the  pharmacopoeia;  but  it  is  more 
than  this,  in  that  it  treats  of  a  vast  number  of  substances  that  are  not 
official,  and  discusses  the  uses  of  drugs.  But  it  is  not  an  authorized  work 
as  is  the  pharmacopoeia. 

The  National  Formulary  is  a  very  important  collection  of  formulas 
that  are  not  official,  but  which  are  in  common  use.    It  is  prepared  under 


INTRODUCTION  19 

the  direction  of  the  American  Pharmaceutical  Association,  and  is,  there- 
fore, in  a  sense  authoritative.  The  abbreviation  (N.  F.)  is  used  to  indi- 
cate this  work. 

In  the  study  of  the  practical  values  and  uses  of  remedies  we  employ 
several  related  terms  which  are  too  often  confused.  Physiologic  action, 
physiologic  effect  and  therapeutic  effect  are  terms  distinct  in  meaning,  and 
they  should  be  properly  understood.  The  action  and  the  effect  of  a 
drug  cannot  be  the  same.  The  action  may  be  obscure;  the  effect  must 
be  apparent.  .  To  illustrate :  Tincture  of  iodine  applied  in  case  of  peri- 
cementitis has  its  action  upon  the  mucous  membrane  (with  indeed  a 
local  destructive  effect  which  is  not  physiologic),  but  the  physiologic 
effect  that  we  desire  is  alteration  of  the  disturbed  circulation  in  the  peri- 
cementum. Again,  we  may  have  physiologic  action  and  physiologic 
effect  without  therapeutic  effect,  the  latter  depending  upon  a  relief  of 
symptoms.  In  the  above  condition  the  therapeutic  effect  would  be  relief 
of  the  pain;  but  the  inflammation  might  be  so  severe  that  our  therapeutic 
effect  would  not  follow. 

The  action  of  a  drug,  then,  consists  of  a  modification  of  conditions, 
chemic,  thermic,  electric  or  structural,  which  determines  an  alteration 
of  function.  This  alteration,  when  apparent,  is  known  as  the  effect  of 
the  drug.  Within  the  limit  of  normal  function  this  effect  is  physiologic, 
while  a  disturbance,  or  depression  beyond  the  normal,  is  a  toxic  effect. 
^  When  the  action  is  in  the  direction  of  restoring  normal  conditions,  the 
effect  is  usually  a  relief  of  symptoms  of  disease,  and  is  called  the  thera- 
peutic effect.  We  may  have  the  action  and  the  physiologic  effect  of  a 
drug  in  a  normal  or  healthy  individual,  but  never  the  therapeutic  effect. 
The  presence  of  disease  is  always  necessary  to  the  production  of  any 
therapeutic  effect. 

Some  drugs  may  cause  unpleasant  or  undesirable  effects  aside  from 
their  main  action.  These  are  called  untoward  effects,  and  their  avoid- 
ance calls  for  discrimination  in  administration  and  dosage.  Closely 
related  is  the  matter  of  susceptibility  to  drug  action,  some  individuals 
being  very  sensitive  to  the  influence  of  a  certain  drug  or  drugs,  and  read- 
ily showing  untoward  effects  of  the  same.  On  the  other  hand,  tolerance 
to  certain  drugs  may  be  acquired  by  continued  use,  so  that  very  large 
quantities  may  be  taken  without  dangerous  results.  The  habit  drugs, 
particularly  morphine  and  cocaine,  exhibit  this  fact;  victims  of  habitual 
use  of  either  often  being  able  to  take  many  times  the  poisonous  dose. 

A  cumulative  effect  is  sometimes  seen  with  slowly  acting  drugs,  par- 
ticularly when  elimination  is  faulty.     The  successive  doses  given  accu- 


20  DENTAL  MATERIA  MEDIC  A 

mulate  and  their  full  action  is  likely  to  be  excessive,  disturbing,  or  poison- 
ous. Digitalis  is  a  drug  which  needs  care  in  its  use  to  avoid  cumulative 
effect. 

As  related  to  the  employment  of  remedies,  the  term  indication  means 
the  symptom  or  condition  that  calls  for  a  particular  remedy  or  course 
of  treatment,  while  contraindication  means  the  condition  or  symptom 
that  forbids  the  use  of  a  certain  remedy  or  method.  A  symptom  is  an 
evident  disturbance  or  alteration  of  function  or  structure,  which  is  the 
expression  of  disease.  A  sign  is  a  symptom  or  phenomenon  that  is  posi- 
tive evidence  of  some  particular  disease.  Diagnosis  means  the  deter- 
mination, by  means  of  symptoms  or  signs,  of  the  character  or  name  of 
the  disease,  while  prognosis  is  the  prediction  of  the  course  or  termination 
of  the  same. 

The  term  resolution  indicates  the  changes  in  diseased  tissues  toward 
the  normal,  and  means  structural  recovery.  Dissolution,  on  the  con- 
trary, means  death.  The  term  specific  has  two  meanings.  Applied  to 
a  remedy,  it  means  that  the  remedy  can  be  invariably  relied  upon  to  pro- 
duce a  therapeutic  effect  in  a  certain  disease,  as  quinine  in  malarial  fever 
or  antitoxin  in  diphtheria;  but  when  we  speak  of  specific  disease  we  mean 
syphilis.  Thus,  the  term  is  used  among  physicians  to  designate,  in  a 
way  that  cannot  give  offence,  that  disease  that  in  its  true  name  has  the 
stigma  of  vice  attached  to  it. 


CHAPTER    I. 

DRUGS  AND  MEDICINES:  THEIR  CONSTITUENTS  AND 
PREPARATIONS. 

The  terms  drug  and  medicine  are  not  strictly  synonymous,  although 
popularly  so  regarded.  Both  mean  material  substances,  therefore  they 
exclude  such  agents  as  heat,  light  and  electricity.  All  medicines  are  drugs, 
but  all  drugs  are  not  medicines.  The  term  medicine  implies  use  in  the 
treatment  of  disease,  while  the  classes  of  drugs  include  many  substances 
that  are  known  usually  as  chemicals  and  that  are  never  used  directly 
in  treatment.  The  following  definitions  show  the  essential  difference  in 
the  meaning  of  the  terms. 

A  medicine  is  any  substance  administered  or  applied  in  the  treatment 
of  disease. 

A  drug  is  any  substance  used  in  the  composition  of  medicines  or  in 
chemical  processes. 

Drugs  are  classified  variously:  in  respect  of  their  sources,  as  vegetable 
drugs,  mineral  drugs  and  animal  drugs;  regarding  their  constitution, 
as  organic  and  inorganic;  and  respecting  their  uses,  as  medicinal  and 
chemical  drugs. 

A  poisonous  drug  is  one  which  is  capable  of  causing  a  disturbance  of 
function,  or  disease,  or  death.  Poisons  must  be  included  among  drugs, 
but  in  their  poisonous  quantities  they  cannot  be  medicines,  although  a 
substance  that  in  a  large  dose  is  a  poison  may  in  a  smaller  dose  be  a 
medicine.    Poisons  are  discussed  in  greater  detail  in  a  separate  chapter. 

The  term  remedy  is  quite  inclusive,  meaning  any  agent  (whether  a 
substance,  a  force,  or  any  influence  whatever)  employed  in  the  treatment 
of  disease.  In  another  chapter  occurs  the  classification  and  discussion 
of  remedies. 

In  the  development  of  the  science  of  drugs,  the  beginning  had  to  be 
with  two  quite  distinct  groups  of  substances — ^the  simple  chemicals,  or 
chemical  elements  as  we  now  know  them,  such  as  zinc,  mercury  and 
iron,  and  the  more  complex  organic  vegetable  drugs,  such  as  opium, 
cinnamon  and  ipecacuanha.  The  former  were  found  to  possess  com- 
paratively slight  medicinal  value  while  in  their  simple  form,  and  except 

(21) 


22  DENTAL  MATERIA    MEDIC  A 

for  their  power  of  chemical  combination  would  have  remained  of  little 
use.  Their  great  value,  therefore,  depends  upon  the  large  number  of 
useful  combinations  which  they  form.  To  illustrate :  Mercury  or  quick- 
silver in  its  pure  form  is  insoluble  and  non-medicinal,  but  combined  with 
chlorine  in  a  certain  proportion  it  yields  calomel,  a  valuable  cathartic, 
and  in  another  proportion  it  yields  corrosive  sublimate,  a  powerful  anti- 
septic; again,  it  may  be  combined  with  sulphur  to  produce  a  valuable 
red  coloring  agent  known  as  vermilion.  And  the  almost  endless  variety 
of  actual  and  possible  combinations  among  the  seventy-five  chemical 
elements  now  known,  provides  a  field  from  which"  we  draw  the  great 
majority  of  agents  used  in  dentistry,  with  a  limitless  future  as  to  new 
compounds. 

Much  of  both  scientific  and  commercial  activity  is  being  expended  in 
the  synthesis,  or  putting  together,  of  chemicals  in  order  to  secure  new 
valuable  compounds.  The  products  are  often  referred  to  as  synthetics. 
Phenacetin  and  saccharin  are  examples  of  this  class.  Remarkable  also 
it  is,  that,  besides  new  products,  many  of  the  active  principles  originally 
obtained  from  organic  drugs  are  now  reproduced  synthetically  in  the 
laboratory.  Of  such,  salicylic  acid  and  artificial  oil  of  wintergreen 
furnish  examples. 

The  substances  of  the  latter  group  mentioned  above,  the  organic  drugs, 
present  a  contrast  to  these,  not  only  in  being  valuable  in  their  original 
form,  but  as  lending  themselves  to  division  and  analysis  rather  than  to 
combination.  They  are  complex  in  their  composition,  therefore  one 
organic  drug  may  contain  from  one  to  a  dozen  or  more  distinct  sub- 
stances of  medicinal  value.  These  are  called  constituents  or  proximate 
principles  of  the  drug.  For  example,  opium,  the  juice  of  the  unripe 
seed-capsule  of  the  opium  poppy,  contains  gum,  albumin,  sugar,  wax, 
pectin,  salts,  caoutchouc,  acids,  and  at  least  twenty  alkaloids,  among 
which  are  morphine  and  codeine.  A  great  deal  of  the  work  being  now 
done  upon  these  complex  drugs  is  that  of  isolating  their  active  principles 
or  constituents  in  a  state  of  purity  and  stability;  and  when  a  single  prin- 
ciple is  found  to  represent  the  drug  fully  it  is  commonly  used  in  its 
stead. 

The  classes  of  chemical  medicines,  therefore,  will  comprise  chiefly 
the  simple  chemical  elements  and  their  many  combinations,  while  those 
of  organic  medicines  will  comprise  the  crude  substances  of  vegetable 
and  animal  orgin  and  their  isolated  active  principles. 

Nearly  all  of  the  organic  and  many  chemical  drugs  are  not  in  proper 
form  for  administration  without  further  preparation,  hence  we  include 


DRUGS  AND  MEDICINES  23 

with  them  a  large  number  of  preparations  which  represent  more  or  less 
completely,  in  medicinal  value,  the  simple  or  crude  substances. 

It  would  be  interesting  to  trace  the  development  of  pharmacy  in 
bringing  forth  the  different  kinds  of  preparations,  in  response  always 
to  definite  needs,  and  to  note  individual  characteristics  in  each  class; 
but  it  must  suffice  to  state  in  general  that  they  fulfil  needs  in  preparation, 
such  as  solubility  and  permanency,  and  likewise  needs  in  administration, 
such-as  pleasant  form  and  taste,  definiteness  of  strength,  external  uses,  etc. 

These  preparations  are  obtained  by  simple  solution  of  a  drug,  by 
extraction  of  its  active  principles,  or  by  incorporation  of  it  with  a  vehicle, 
the  objects  of  such  preparations  being  to  secure  the  medicine  in  a  suitable 
form,  in  definite  strength,  and  in  a  permanent  or  stable  condition.  Occa- 
sionally chemical  action  is  employed,  but  the  larger  number  are  produced 
without  any  chemical  change  occurring  in  the  ingredients.  The  prep- 
arations produced  without  chemical  action  are  known  as  galenical 
preparations,  being  so  named  after  the  ancient  physician  Galen. 

The  need  of  standards  of  strength  for  these  drugs  and  their  prepara- 
tions has  long  been  apparent  from  the  observed  variability  in  their  action. 
The  amount  of  active  principle  present  seemed  to  present  the  best  basis 
for  standardization,  and  much  progress  has  been  made  in  recent  years 
in  establishing  processes  of  assay  to  which  the  substances  must  conform. 
This  feature  has  been  developed  in  the  Pharmacopoeia  to  such  an  extent 
that  the  book  now  includes  methods  of  assay  for  nearly  fifty  different 
drugs,  besides  many  of  their  preparations.  This  contributes  very  much 
to  definiteness  and  insures  greater  reliability  and  accuracy  in  the  use  of 
our  most  important  medicines. 

Among  all  of  the  classes,  the  fiuidextracts  deserve  emphasis  as  the  most 
representative  preparations  of  the  crude  organic  drugs.  They  are  so 
prepared  as  to  contain  all  of  the  active  principles,  to  be  of  a  uniform, 
definite  strength,  and  to  keep  indefinitely.  The  tinctures  may  be  regarded 
as  second  in  importance,  being  permanent  alcoholic  solutions  of  drugs, 
though  weaker  than  fluidextracts.  Syrups  present  the  drugs  in  form  for 
pleasant  administration,  as  also  do  pills  and  troches.  Plasters,  liniments 
and  ointments  illustrate  the  adaptation  of  drugs  to  external  uses. 

The  various  preparations  are  presented  in  the  following  list,  arranged 
in  classes,  alphabetically,  with  each  class  defined,  and  the  names  given  of 
the  most  important  ones,  or  those  of  interest  to  the  dental  specialist.  The 
names  given,  both  for  each  class  and  each  individual  preparation,  are 
those  employed  in  the  official  volume,  the  U.  S.  Pharmacopoeia. 


24  DENTAL  Materia  medIcA 

CLASSES  OF  OFFICIAL  PREPARATIONS. 

Acetum.  A  Vinegar.  A  solution  of  a  medicinal  substance  in  diluted 
acetic  acid.    Vinegars  have  an  acid  reaction. 

Acetum  opii  (10  per  cent.).  Acetum  scillse. 

Aqua.  A  Medicated  Water.  A  solution  of  a  volatile  substance  in 
water. 

*Aqua  ammonise  (10  per  cent.).  Aqua  cinnamomi. 

*Aqua  ammonise  fortior  (28  per  cent.).    *Aqua  creosoti  (0.70  per  cent.). 

*Aqua  amygdalae  amarse.  *Aqua  hydrogenii  dioxidi  (3  per  cent.). 

Aqua  anisi.  Aqua  menthse  piperitse. 

Aqua  aurantii  florum.  Aqua  menthse  viridis. 

Aqua  aurantii  florum  fortior.  Aqua  rosse. 

Aqua  camphorse.  Aqua  rosse  fortior. 

*Aqua  chloroformi  (0.5  per  cent.). 

Those  marked  thus  (*)  may  be  either  irritating  or  poisonous  when  used  freely.  All 
others  are  harmless,  being  used  mostly  as  flavoring  agents. 

Ceratum.  A  Cerate.  A  preparation  having  a  fatty  base  with  a 
melting  point  above  the  temperature  of  the  body. 

Ceratum.  Ceratum  plumbi  subacetatis. 

Ceratum  camphorse.  Ceratum  resinse. 

Ceratum  cantharidis  (32  per  cent.).  Ceratum  resinse  compositum. 

Cerates  are  used  only  for  local  medication  or  protection. 

Charta.  A  Medicated  Paper.  A  paper  medicated  either  by  absorp- 
tion or  by  adhesion  to  its  surface. 

Charta  potassi  nitratis.    (Not  official.    Used  as  a  fumigation  by  burning.) 
Charta  sinapis.     (Used  as  a  counterirritant.      In  efi^ect  it  is  the  equivalent  of  a 
mustard  plaster  and  much  more  convenient.) 

CoUodium.  A  Collodion.  A  liquid  preparation  for  external  use, 
having  as  a  basis  a  solution  of  guncotton  in  a  mixture  of  ether  and 
alcohol. 

CoUodium. 

CoUodium  cantharidatum.  CoUodium  stypticum  (20  per  cent,  tan- 

CoUodium  flexile.  nicacid). 

Collodia  are  employed  to  protect  or  to  constrict  tissue,  or  to  apply  an 
astringent  or  an  irritant  drug  to  the  skin.  Having  the  nature  of  a  varnish, 
they  cannot  be  applied  unless  the  surface  is  perfectly  dry.  They  dry 
quickly  by  evaporation  of  the  ether  and  alcohol. 


DRUGS  AND  MEDICINES  25 

Decoctum.  A  Decoction.  A  liquid  preparation  made  by  boiling  a 
vegetable  drug  in  water.     Not  used  where  active  principle  is  volatile. 

The  U.  S.  Pharmacopoeia  gives  a  general  formula  for  decoctions  of 
5  per  cent,  strength.  Unless  some  preservative  is  added,  they  do  not 
keep  well;  so  they  must  be  freshly  prepared. 

Elixir.  An  Elixir.  A  sweetened,  aromatic,  spirituous  preparation 
of  one  or  more  drugs,  designed  for  pleasant  administration. 

Elixir  ad ju vans  '  Elixir  ferri,  quininae  et  strychninse  phos- 

Elixir  aromaticum,  phatum. 

Some  elixirs  are  used  only  as  vehicles,  their  alcoholic  character  per- 
mitting the  addition  of  fluidextracts  without  precipitation.  The  National 
Formulary  contains  the  formulas  of  a  large  number  of  elixirs  for  the  ad- 
ministration of  drugs  of  unpleasant  taste. 

Emplastrum.  A  Plaster.  A  solid  preparation  for  external  use, 
adhesive  at  the  temperature  of  the  body. 

Emplastrum  adhsesivum.  Emplastrum  opii. 

Emplastrum  belladonnae.  Emplastrum  plumbi. 

Emplastrum  capsici.  Emplastrum  resinse. 

Emplastrum  hydrargyrl.  Emplastrum  saponis. 
*Emplastrum  ichthyocollae. 

These  are  usually  spread  upon  muslin  and  are  intended  for  protection 
to  the  skin,  or  for  the  application  of  either  irritating  or  sedative  drugs. 

Emulsum.  An  Emulsion.  A  liquid  preparation  in  which  oil  or  resin- 
ous matter  is  held  in  suspension  in  water.  They  require  a  viscid  or 
mucilaginous  substance  in  order  to  effect  and  maintain  the  suspension 
of  the  insoluble  particles. 

Emulsions  are  in  no  sense  solutions,  their  object  being  to  carry  sub- 
stances that  are  not  soluble  in  water.  In  case  of  asafoetida,  a  gum-resin, 
there  is  sufficient  gum  in  the  drug  to  carry  the  resin,  so  that  the  emulsion 
is  formed  by  rubbing  up  the  drug  with  water  without  adding  anything  else. 

Emulsum  amygdalae.  Emulsum  olei  morrhuse  cum  hypophos- 
Emulsum  asafcetidse  (4  per  cent.).  phitibus. 

Emulsum  chloroformi  (4  per  cent.).  Emulsum  olei  terebinthinse 
Emulsum  olei  morrhuse  (cod-liver  oil). 

Emulsion  of  cod-liver  oil  is  largely  used,  two  official  formulas  being 
given;  the  National  Formulary  also  furnishes  a  number,  also  one  for 
castor  oil. 

*  Court-plaster,  an  exception  to  the  rule,  is  applied  with  moisture.    (Not  official.) 


26 


DENTAL  MATERIA  MEDtCA 


Extractum.    An  Extract.    A  solid  or  semisolid  concentrated  prepara- 
tion of  the  soluble  constituents  of  a  drug. 


Extractum  aloes. 

Extractum  hyoscyami. 

Extractum  belladonnse  foliorum. 

Extractum  kramerise. 

Extractum  cannabis  indicae. 

Extractum  malti. 

Extractum  colchici  cormi. 

Extractum  nucis  vomicse. 

Extractum  colocynthidis. 

Extractum  opii. 

Extractum  colocynthidis  compositum 

Extractum  physostigmatis. 

Extractum  digitalis. 

Extractum  rhamni  purshianse. 

Extractum  ergotse. 

Extractum  quassise. 

Extractum  gentiange. 

Extractum  rhei. 

Extractum  glycyrrhizse. 

Extractum  scopolse. 

Extractum  glycyrrhizse  purum. 

Extractum  stramonii. 

Extractum  hsematoxyli. 

Extractum  taraxaci. 

The  object  of  this  class  is  chiefly  concentration  of  the  drug,  but  the 
keeping  qualities  are  usually  also  improved.  The  form  permits  of  their 
being  made  readily  into  pills,  or  of  ready  solution. 

Fluidextractum.  A  Fluidextract.  An  alcoholic  or  hydroalcoholic 
solution,  one  cubic  centimeter  of  which  represents  one  gram  of  the  crude 
drug.  [Acids  or  alkalies  are  sometimes  used  to  aid  in  the  extraction  of 
the  principles.] 


Flui  dextraetum 
Flui  dextraetum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 


aconiti. 

aurantii  amari. 

belladonnge  radicis. 

berberidis. 

buchu. 

calumbse. 

cannabis  indicse. 

cinchonse. 

cocse. 

convallarise. 

digitalis. 

ergotse. 

frangulse. 

gentianse. 

glycyrrhizae. 

guaranse. 

hamamelidis  foliorum. 

Hydrastis. 

hyoscyami. 

ipecacuanhas. 


Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
aromaticum. 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 
Fluidextractum 


kramerise. 
nucis  vomicse. 
pilocarpi, 
pruni  virginianse. 
quassias. 

rhamni  pursliianse. 
rhamni     purshianae 

rhei. 

rubi. 

sarsaparillse. 

scillse. 

scopolse. 

senegse. 

sennse. 

stramonii. 

uvse  ursi. 

Valerianae. 

veratri. 

zingiberis. 


Fluidextracts  constitute  the  largest  and  most  representative  class  of 
preparations,  there  being  85  oflBcial.  Their  drug  strength  is  uniformly 
100  per  cent. 


DRUGS  AND  MEDICINES  27 

Glyceritum.    A  Glycerite.     A  solution  of  a  medicinal  substance  in 
glycerin. 

Glyceritum  acidi  tannici  (20  per  cent.).    Glyceritum  hydrastis  (100  per  cent.). 
Glyceritum  amyli  (10  per  cent.).  Glyceritum  ferri,  quininge  et  strychninse 

Glyceritum  boroglycerini  (31  per  cent.         phosphatum. 

of  boric  acid).  *Glyceritum  phenolis  (20  per  cent.). 

Infusum.  An  Infusion.  A  liquid  preparation  made  by  macerating 
a  vegetable  drug  in  hot  or  cold  water. 

Infusum  digitalis.  Infusum  sennfe  compositum. 

Infusum  pruni  virginianse. 

There  is  also  a  general  formula  for  infusions  of  5  per  cent,  strength. 
These  preparations  do  not  keep  well.     Either  they  must  be  freshly 
made  or  some  preservative  added. 

Linimentum.  A  Liniment.  A  liquid  preparation  for  external  use, 
usually  possessing  a  stimulating  or  sedative  property.  Liniments  vary 
much  in  character,  but  most  of  them  contain  some  oil  or  soap. 

Linimentum  ammonia.  Linimentum  chloroformi  (-30  per  cent.). 

Linimentum  belladonnse.  Linimentum  saponis. 

Linimentum  calcis.    Carron  oil.  Linimentum  saponis  mollis. 

Linimentum  camphorte.     Camphor-      f  Linimentum  terebinthinaj  (35  per  cent.). 

ated  oil. 
Liquor.     A  Solution.     An  aqueous  solution  of  one  or  more  non- 
volatile substances.     [In  some  a  chemical  reaction  is  employed  to  obtam 
the  desired  product.] 

Liquor  ammonii  acetatis.  Liquor  iodi  compositus  (5  per  cent. 

Liquor  antisepticus.  iodine). 

Liquor  arseni  et  hydrargyri  iodidi.  Liquor  magnesii  citratis. 

Liquor  arseni  trioxidi  (1  per  cent.).  Liquor  plumbi  subacetatis. 

Liquor  calcis.    Lime-water.  Liquor  plumbi  subacetatis  dilutus. 

Liquor  chlori  compositus  (0.4  per  cent     Liquor  potassii  arsenitis. 

chlorine).  Liquor  potassii  citratis. 

Liquor  cresolis  compositus.  Liquor  potassii  hydroxidi  (.5  per  cent.). 

Liquor  ferri  chloridi.  Liquor  sodse  chlorinatse  (2.4  per  cent. 
Liquor  ferri  et  ammonii  acetatis.  chlorine). 

Liquor  ferri  subsulphatis.     Monsel's  Liquor  sodii  arsenatis. 

solution.  Liquor  sodii  hydroxidi  (5  per  cent.). 

Liquor  ferri  tersulphatis.  Liquor  sodii  silicatis  (not  official). 

Liquor  formaldehydi.  Liquor  zinci  chloridi  (.50  per  cent.). 
Liquor  hydrargyri  nitratis. 

*  Formerly  glyceritum  acidi  carbolici. 

t  Linimentum  terebinthina;  (turpentine  liniment)  may  be  semisolid. 


^S  DENTAL  MATERIA  MEDIC  A 

Massa.  A  Mass.  A  mixture  of  substances  of  the  proper  consistence 
to  be  made  into  pills. 

Massa  ferri  carbonatis.  Massa   hydrargyri.     Blue   fill    (33   per 

cent,  mercury). 

Mistura.  A  Mixture.  An  aqueous  liquid  preparation  usually  hold- 
ing some  insoluble  matter  in  suspension. 

Mistura  cretse.  Mistura  glycyrrhizse  comp.    Brown  mix- 

Mistura  ferri  composita.  ture. 

Mistura  rhei  et  sodse. 

Mucilago.  A  Mucilage.  A  solution  of  a  gum  or  vegetable  mucilage 
in  water.  Mucilages  are  used  as  demulcents,  or  as  excipients  in  various 
preparations. 

Mucilago  acacise  (34  per  cent.).  Mucilago  tragacanthae. 

Mucilago  sassafras  medullse.  Mucilago  ulmi. 

Oleatum.  An  Oleate.  A  solution  of  a  medicinal  substance  in  oleic 
acid.     Oleic  acid  here  contributes  a  superior  penetrating  quality. 

Oleatum  atropinse  (2  per  cent.).  Oleatum  quininse  (25  per  cent.). 

Oleatum  cocainse  (5  per  cent.).  Oleatum  veratrinse  (2  per  cent.). 

Oleatum  hydrargyri  (25  per  cent,  yel- 
low oxide). 

Oleoresina.  An  Oleoresin.  A  liquid  or  semiliquid  mixture,  chiefly 
of  oil  and  resin,  extracted  from  the  drug  by  percolation  with  ether, 
[They  are  really  ethereal  extracts.] 

Oleoresina  aspidii.  Oleoresina  lupulini. 

Oleoresina  capsici.  Oleoresina  piperis. 

Oleoresina  cubebse.  Oleoresina  zingiberis. 

The  term  also  applies  to  certain  natural  products,  consisting  of  mix- 
tures of  oil  and  resin,  which  occur  as  exudates  from  the  trees  containing 
them.    These  may  be  liquid  or  solid.    Examples  are: 

Copaiba  (liquid).  Terebinthina  (solid). 

Oleum.  An  Oil.  A  natural  compound  of  one  or  more  of  the  fatty 
acids  with  glycerin.  True  oils  and  fats  must  be  capable  of  saponifica- 
tion, i.  e.,  forming  a  soap  when  treated  with  an  alkali.  They  vary  in 
consistence  and  in  melting  point,  chiefly  on  account  of  the  varying  pro- 
portions of  olein,  palmitin  and  stearin  which  they  contain.  They  are 
not  volatile.  They  occur  naturally  in  animal  tissues  and  in  the  seeds  of 
many  plants  and  trees. 

Oleum  amygdalae  expressum.  Oleum  olivse.  Olive  oil. 

Oleum  gossypii  seminis.  Oleum  ricini.  Castor  oil. 

Oleum  lini.     Linseed  oil.  Oleum  tiglii.  Croton  oil. 
Oleum  morrhuse.    Cod-liver  Oil. 


DRUGS  AND  MEDICINES  29 

The  solid  fats  are: 

Adeps.     Lard.  Oleum  theobromatis. 

Adeps  lanse.     Lanolin.  Sevum  prseparatum.     Suet. 

Spermaceti  and  wax  are  similar  to  these  in  that  they  are  saponifiable, 
but  they  contain  no  glycerin.  Petrolatum  (vaselin)  is  not  a  fat,  although 
it  may  be  used  as  a  basis  in  ointments. 

Oleum  Destillatum.  A  Distilled  Oil.  [Volatile  Oil.  Essential  Oil.] 
A  volatile,  oily  principle  usually  obtained  from  the  crude  drug  by  dis- 
tillation. They  are  not  saponifiable,  therefore  they  are  not  true  oils. 
The  volatile  oils  are  usually  the  essential  principles  of  the  plants  yielding 
them.    It  will  be  noticed  that  many  of  them  are  obtained  from  spices. 

Oleum  sethereum.  Oleum  juniperi. 
*01eum  amygdalae  amarse  (bitter  almond).     Oleum  lavandulse  florum. 

Oleum  anisi  (anise.)  Oleum  limonis  (lemon). 

Oleum  aurantii  corticis  (orange-peel).  Oleum  menthae  piperitse  (peppermint). 

f Oleum  aurantii  florum  (orange  flowers).  Oleum  menthse,  viridis  (spearmint). 

fOleum  bergamottse  (bergamot).  Oleum  myristicse  (nutmeg). 

Oleum  betulse  (sweet  birch).  Oleum  picis  liquidse  (wood  tar). 

Oleum  cajuputi.  Oleum  pimentse  (allspice). 

Oleum  cari  (caraway).  Oleum  rosge. 

Oleum  caryophylli  (cloves).  Oleum  sassafras. 

Oleum  cinnamomi.  *01eum  sinapis  volatile  (mustard). 

Oleum  eucalypti  (contains  eucalyptol).  Oleum  tercbinthinse  (turpentine). 

Oleum  gaultherise  (winter green).  Oleum  thymi. 

PiMa.  A  Pill.  A  spherical  or  oval  mass,  containing  one  or  more 
medicinal  ingredients,  intended  to  be  swallowed  whole. 

Pilulse  (plur.)  aloes  (gr.  2  in  each).  Pilulse  ferri  iodidi. 

Pilulse  aloes  et  ferri.  Pilxilse  laxativse  compositse. 

Pilulse  asafoetidse  (gr.  3  in  each).  Pilulse  opii  (gr.  1  in  each). 

Pilulse   catharticse   compositse    (gr.    1  Pilulse  phosphori  (gr.  y^o  in  each) . 

of  calomel  included  in  each  pill).  Pilulse  podophylli,  belladonnse  et  capsici. 

Pilulse  catharticse  vegetabiles.  Pilulse  rhei  compositse. 
Pilulse  ferri  carbonatis. 

The  chief  object  in  the  use  of  pills  is  to  avoid  the  unpleasant  taste  of 
medicines.  Sometimes,  however,  they  may  be  used  in  order  to  secure 
a  slow  or  delayed  absorption  of   the  medicine. 

*  These  do  not  exist  ready  formed  in  the  drug,  but  are  developed  when  the  drug  is 
moistened  with  water,  in  the  presence  of  which  a  reaction  between  certain  constituents 
occurs,  with  the  formation  of  the  volatile  oil.  This  process  must  precede  distillation 
in  case  of  these.  With  the  exception  of  these  two,  which  are  poisonous  and  should 
never  be  given  in  larger  dose  than  ITLi  (0.03  gm.),  the  dose  of  the  volatile  oils  is  TT],  1-5 
(0.06-0.30  gm.). 

t  Not  ofl&cial. 


30  DENTAL  MATERIA  MEDIC  A 

Resina.  A  Resin.  A  solid  preparation  cojisisting  chiefly  of  resinous 
substances.  They  are  insoluble  in  water,  and  are  usually  obtained  by 
precipitation  from  tinctures  by  the  addition  of  water.  They  soften  with 
the  aid  of  heat. 

Resina.     Rosin.  Resina  podophylli. 

Resina  jalapse.  Resina  scammonii. 

Resins  as  a  class  are  soluble  in  alcohol,  ether,  chloroform,  and  oils. 

Gum-resins  are  related  to  the  above,  but  differ  from  them  in  compo- 
sition and  solubility.  They  contain  a  gum  associated  with  the  resin; 
therefore  they  are  only  partly  soluble  in  alcohol  and  are  partly  soluble 
also  in  water.     The  two  most  important  ones  are: 

Asafoetida.  Myrrh. 

Balsamic  Resins  and  Balsams  also  belong  to  the  group  of  resinous 
substances,  being  characterized  by  the  presence  of  benzoic  or  cinnamic 
acid.     They  include: 

Benzoinum.  Balsamum  peruvianiim. 

Styrax.  Balsamum  tolutanum. 

Sapo.  A  Soap.  An  alkaline  product  of  the  reaction  between  a  fatty 
acid  and  either  soda  or  potassa.*  Soaps  are  prepared  by  heating  a  fat 
or  oil  with  an  alkali — potassa  yielding  a  soft  soap  and  soda  a  hard  soap. 

Sapo.  Sapo  mollis. 

Spiritus.  A  Spirit.  An  alcoholic  solution  of  a  volatile  substance. 
Many  of  the  spirits  are  prepared  from  the  volatile  oils. 

Spiritus  getheris  (32.5  per  cent.).  Spiritus  gaultherise  (.5  per  cent.  oil). 

Spiritus  setheris  compositus  (32.5  per  *Spiritus  glycerylis  nitratis  (1  per  cent, 

cent.).  nitroglycerin.) 

Spiritus  setheris  nitrosi.  Spiritus  juniperi  (5  per  cent.  oil). 

Spiritus  ammonise  (10  per  cent.).  Spiritus  juniperi  compositus. 

Spiritus  ammonise  aromaticus.  Spiritus  Lavandula;  (5  per  cent.  oil). 

Spiritus  amygdalse  amarse  (1  per  cent.  Spiritus  limonis  (5  per  cent,  oil,  lemon- 
volatile  oil.)  peel  added.     Not  official.) 

Spiritus  anisi  (10  per  cent.  oil).  Spiritus  menthse  piperitse  (10  per  cent. 

Spiritus  aurantii  compositus.  oil). 

Spiritus  camphorse  (10  per  cent.).  Spiritus  menthse  viridis  (10  per  cent.  oil). 

Spiritus  chloroformi  (6  per  cent.).  Spiritus  myrcise.    Bay  rum  (not  official). 

Spiritus  cinnamomi  (10  per  cent.  oil).  Spiritus  vini    gallici     (46-55  per    cent. 

Spiritus    frumenti   (44-55   per   cent.  alcohol), 
alcohol). 

*  This  definition  is  a  restricted  one,  intended  to  define  the  official  soaps.  Chem- 
ically speaking,  the  salt  of  a  fat  acid  with  any  inorganic  base  is  a  soap. 


DRUGS  AND  MEDICINES 


31 


Suppositorium.  A  Suppository.  A  solid,  conical  mass,  containing 
one  or  more  medicinal  substances,  intended  for  introduction  into  some 
passage  or  cavity  of  the  body.  A  suppository  should  melt  readily  at  the 
temperature  of  the  body,  to  ensure  which  a  base  of  either  cacao  butter 
or  glycerinated  gelatin  is  commonly  employed.  The  size  may  vary  from 
15  to  45  grains  (grams  1  to  3).  The  U.  S.  P.  gives  general  directions 
for  their  preparation  with  either  base. 

They  are  made  of  different  shapes,  according  to  the  particular  use  for 
which  they  are  intended.  Those  for  introduction  into  the  urethra, 
often  called  bougies,  are  pencil  shaped,  while  for  rectal  and  vaginal  use 
they  are  conical  or  oval. 

The  following  is  exceptional  in  being  prepared  with  sodium  stearate 
as  a  base,  and  in  being  used  simply  as  laxative,  acting  by  local  irritation. 

Suppositoria  (plur.)  glycerini.  (These  contain  about  80  per  cent,  of  glycerin 
with  a  soap  for  a  base.) 

Syrupus.  A  Syrup.  An  aqueous  medicinal  solution  containing  sugar 
nearly  to  saturation.  [A  few  syrups  are  without  decided  medicinal  value, 
being  used  chiefly  as  vehicles.] 

Being  rather  thick  in  consistence,  they  may  hold  solid  particles  in 
suspension,  thus  possessing  added  value  as  excipients,  and  their  con- 
sistence also  gives  them  something  of  the  quality  of  demulcents.  As  a 
rule,  they  are  weaker  than  tinctures. 

Two  objects  are  secured  in  this  class  of  preparations — preserv^ation 
and  pleasant  taste — both  of  which  are  due  to  the  large  amount  of  sugar 
present. 


Syrupus  (85  per  cent,  sugar). 

Syrupus  acacise. 

Syrupus  acidi  citrici. 

Syrupus  acidi  hydrodici. 

Syrupus  amygdalae. 

Syrupus  aurantii. 

Syrupus  aurantii  florum. 

Syrupus  calcii  lactophosphatis. 

Syrupus  calcis. 

Syrupus  ferri  iodidi. 

Syrupus  ferri,  quininee  et  strychninse 

phosphatum. 
Syrupus  hypophosphitum. 
Syrupus  hypophosphitum  compositus. 
Syrupus  ipecacuanhse. 


Syrupus  kramerise. 

Syrupus  lactucarii. 

Syrupus  picis  liquidse. 

Syrupus  pruni  virginianae. 

Syrupus  rhei. 

Syrupus  rhei  aromaticus. 

Syrupus  rosse. 

Syrupus  rubi. 

Syrupus  sarsaparillse  compositus. 

Syrupus  scillse. 

Syrupus  scillae  compositus. 

Syrupus  senegse. 

Syrupus  sennse. 

Syrupus  tolutanus. 

Syrupus  zingiberis. 


32 


DENTAL  MATERIA  MEDICA 


Tinctura.  A  Tincture.  An  alcoholic  or  hydroalcoliolic  solution  of 
a  crude  drug  or  of  a  non- volatile  substance.  Tinctures  are  weaker  than 
fluidextracts  and  have  no  uniform  strength  as  a  class. 


Tinctura  aconiti. 

Tinctura  ipecacuanhse  et  opii  (10  per 

Tinctura  aloes  et  myrrhse. 

cent,  opium). 

Tinctura  asafoetidse. 

Tinctura  kino. 

Tinctura  aurantii  amari. 

Tinctura  kramerise. 

Tinctura  aurantii  dulcis. 

Tinctura  lavandulse  composita. 

Tinctura  belladonna3  foliorum. 

Tinctura  limonis  corticis. 

Tinctura  benzoini. 

Tinctura  myrrhse. 

Tinctura  benzoini  composita. 

Tinctura  nucis  vomicae. 

Tinctura  calumbse. 

Tinctura  opii  (10  per  cent.). 

Tinctura  cantharidis.. 

*Tinctura  opii  camphorata  (0.4  per  cent. 

Tinctura  capsici. 

opium). 

Tinctura  cardamomi  composita. 

Tinctura  opii  deodorati  (10  per  cent.). 

Tinctura  cinchonse. 

Tinctura  pyrethri. 

Tinctura  cinchonse  composita. 

Tinctura  quassise. 

Tinctura  cinnamomi. 

Tinctura  rhei. 

Tinctura  digitalis. 

Tinctura  rhei  aromatica. 

Tinctura  ferri  chloridi. 

Tinctura  scillse. 

Tinctura  gallse. 

Tinctura  strophanthi. 

Tinctura  gambir  composita. 

Tinctura  tolutana. 

Tinctura  gentianse  composita. 

Tinctura  Valerianae. 

*Tinctura  guaiaci  ammoniata. 

*Tinctura  Valerianae  ammoniata. 

Tinctura  Hydrastis. 

Tinctura  veratri. 

Tinctura  hyoscyami. 

Tinctura  zingiberis. 

*Tinctura  iodi  (7  per  cent.). 

Iti  point  of  number  and  importance  tinctures  hold  a  place  second  only 
to  fluidextracts.  There  are  63  official,  besides  the  following  general 
formula : 

Tincturse  Herbarum  Recentium.  Tinctures  of  Fresh  Herbs.  A 
general  formula  for  these  is  official,  directing  50  parts  of  the  fresh  herb 
to  be  macerated  in  100  parts  of  alcohol  for  fourteen  days. 

Trituratio.  A  Trituration.  A  powder  consisting  of  a  potent  drug 
diluted  and  finely  divided  by  means  of  sugar  of  milk.  The  U.  S.  P.  gives 
a  general  formula  for  the  preparation  of  10  per  cent,  triturations.  The 
following  is  the  only  official  one  named  separately: 

Trituratio  elaterini. 

(See  remarks  on  tablet  triturates  following.) 

*  In  these  some  of  the  medicinal  constituents  are  quite  volatile. 


DRUGS  AND  MEDICINES  33 

Trochiscus.  A  Troche  or  Tablet.  A  solid  preparation  in  tablet 
form,  consisting  of  one  or  more  medicinal  substances  combined  with 
sugar  and  mucilage. 

Trochisci    (plur.)    acldi    tannic!    (gr.  Trochisci  menthse  piperitse  (ttl  I  of  oil 

1  in  each).  in  each). 

Trochisci   ammonii    chloridi    (gr.    1^  Trochisci     morphinse    et    ipecacuanhse 

in  each).  (gr.  -^^  of  morphine  in  each). 

Trochisci  cubebse  (n\^  f  of  oleoresin  Trochisci  potassii  chloratis   (gr.  2^  in 

in  each).  each). 

Trochisci  gambir  (gr.  1  in  each).  Trochisci  santonini  (gr.  J  in  each). 

Trochisci  glycyrrhizre  et  opii  (gr.  j^  Trochisci  sodii  bicarbonatis   (gr.   3  in 

of  opium  in  each).  each). 
Trochisci  kramerise  (gr.  1  in  each). 

Several  subdivisions  of  the  class  of  troches  must  now  be  recognized, 
some  of  which  do  not  conform  exactly  to  the  definition  given  above. 

Tablet  Triturates  combine  the  characters  of  the  trituration  and  the 
troche,  having  the  medicine  in  a  finely  divided  state  and  in  a  form  pleas- 
ant to  take.  A  great  variety  of  combinations  are  now  prepared  in  this 
form,  presenting  a  convenience  of  handling  and  of  administration  that 
does  not  obtain  with  the  liquid  forms  of  medicine.  With  some  drugs, 
however,  the  fresh  liquid  preparations  are  more  reliable  and  greatly  to 
be  preferred. 

Hypodermic  Tablets.  For  hypodermic  use  it  is  desirable  to  have 
the  medicine  readily  soluble,  therefore  the  tablet  should  contain  little  or 
nothing  besides  the  active  substance.  With  some  drugs  a  little  mucilage 
may  be  required  to  secure  adhesion  of  the  particles,  but  the  least  possible 
amount  should  be  used. 

Compressed  Tablets.  Many  substances  are  sufficiently  cohesive  to 
admit  of  being  compressed  into  tablet  form  without  the  addition  of  any 
adhesive  material.  Some  that  take  the  tablet  form  readily  do  not  main- 
tain it  indefinitely.  They  may  be  deliquescent  and  become  soft  or  even 
liquid;  or  they  may  be  efflorescent  and  become  dry,  and  crumble.  Such 
will  require  to  be  kept  in  tightly  corked  bottles.  The  compressed  tablets, 
however,  are  very  convenient  and  usually  present  the  drug  in  its  pure 
form. 

Unguentum.  An  Ointment.  A  semisolid  fatty  preparation  for  exter- 
nal use,  having  a  melting  point  near  the  temperature  of  the  body. 

Unguentum  acidi  borici  (10  per  cent.).     Unguentum  diachylon. 

Unguentum  acidi  tannici  (20  per  cent.).     Unguentum  gallse  (20  per  cent.). 

Unguentum  aquse  rosee.  Unguentum  hydrargyri  (50  per  cent.). 

Unguentum  belladonnae  (10   per  cent.     Unguentum  hydrargyri  dilutum  (33 J 
extract).  per  cent.). 

3 


34  DENTAL  MATERIA  MEDICA 

Unguentum  hydrargyri  ammoniati  (10  Unguentum     potassii    ioditli     (10    per 

per  cent.).  cent.). 

Unguentum  iodi  (4  per  cent.).  Unguentum  sulphuris  (15  per  cent.). 

Unguentum  iodoformi  10  per  cent.).  Unguentum  veratrinse  (4  per  cent.). 

Unguentum  phenolis  (3  per  cent.).  Unguentum  zinci  oxidi  (20  per  cent.). 

Unguentum  picis  liquidse  (50  per  cent.).  Unguentum  zinci  stearatis  (50 per  cent.). 

Ointments  are  intended  to  protect,  soften  or  medicate  the  skin.  A 
few,  such  as  unguentum  hydrargyri,  are  used  for  the  purpose  of  systemic 
medication  by  being  rubbed  into  the  skin. 

Vinum.    A  Wine.    A  sohition  of  a  medicinal  substance  in  white  wine. 

Vinum  antimonii.  Vinum  ferri. 

Vinum  cocse.  Vinum  ipecacuanhge  (10  per  cent,  fluid- 

Vinum  colchici  seminis.  extract). 

Vinum  ergotse.  Vinum  opii  (10  per  cent.). 

To  these  may  be  added  the  simple  wines: 

Vinum  album  (sherry).  Vinum  rubrum  (port).  . 

(Each  contains  from  SJ  to  15  per  cent,  by  volume  of  alcohol.) 

CONSTITUENTS  OF  DRUGS. 

As  we  study  the  value  of  an  organic  drug  in  its  desirable  medicinal 
effects,  it  is  evident  that  the  latter  must  be  dependent,  not  upon  the  whole 
drug,  but  upon  the  action  of  one  or  more  of  its  constituents;  for  every 
crude  drug  contains  inert  matter,  while  some  have  constituents  of  un- 
desirable action.  It  is  important  to  know  just  which  of  the  proximate 
principles  are  medicinally  active ;  and  where  such  are  capable  of  isolation 
there  is  evident  advantage  in  their  employment  instead  of  the  preparations 
of  the  whole  drug. 

In  the  foregoing  list  of  preparations  there  are  some  that  are,  as  well, 
simple  constituents.  This  is  true  of  the  oils,  the  distilled  oils  and  the 
resins,  these  being  obtainable  by  simple  means  in  a  fairly  pure  state.  But 
there  are  other  constituents  that  are  less  easily  separated  from  the  drug, 
but  which  are  usually  the  most  active  and  important  of  its  principles. 
Their  recognition  depends  upon  their  possessing  a  definite  chemical 
character  which  is  not  essentially  altered  in  the  process  of  extraction. 

Since  the  recognition  of  morphine  in  opium  by  Setiirner,  in  1817, 
much  effort  has  been  expended  in  securing  the  active  principles  of  the 
various  drugs  in  a  state  of  purity  and  solubility  for  practical  use.  So 
successful  has  the  effort  been  with  many  of  our  leading  drugs  that  their 
quality  is  now  gaged  by  the  amount  of  active  principles  present,  e.  g., 


DRUGS  AND  MEDICINES  35 

opium  cannot  be  official,  nor,  indeed,  can  it  be  imported,  unless  it  con- 
tains 9  per  cent,  of  morphine. 

Of  all  classes  of  active  principles  the  alkaloids  and  the  glucosides  are 
most  important  and  distinct. 

Alkaloids.  These  are  defined  to  be  nitrogenous  compounds  of 
organic  origin,  having  the  reaction  and  basic  property  of  alkalies.  The 
most  prominent  members  of  this  class  are  the  following: 

Aconitine,  obtained  from  aconite.  Morphine,  obtained  from  opivmi. 

Atropine,  obtained  from  belladonna.  Narcotine,  obtained  from  opium. 

Caffeine,    obtained    from    tea,    coffee,  Nicotine,  obtained  from  tobacco. 

and  guarana.  Papaverine,  obtained  from  opium. 

Cinchonine,  obtained  from  cinchona.  Pilocarpine,  obtained  from  pilocarpus. 

Cocaine,  obtained  from  coca.  Quinine,  obtained  from  cinchona. 

Codeine,  obtained  from  opium.  Sparteine,  obtained  from  scoparius. 

Emetine,  obtained  from  ipecacuanha.  Strychnine,  obtained  from  nux  vomicae. 

Hydrastinine,  obtained  from  hydrastis.  Thebaine,  obtained  from  opium. 

Hyoscyamine,  obtained    from    hyoscy-  Veratrine,  obtained  from  asagrsea   offi- 

amus.  cinalis. 

Alkaloids  hare  a  definite  chemical  composition.  Most  of  them  are 
crystallizable,  although  a  few  unimportant  ones  are  liquid,  e.g.,  nico- 
tine. 

As  a  class,  we  must  accord  them  the  pre-eminence  among  medicines. 
Their  action  is  chiefly  upon  the  nervous  system,  through  which  they  may 
exert  an  indirect  influence  upon  other  kinds  of  tissue.  They  have  almost 
no  influence  upon  elimination,  none  of  them  being  classed  among  the 
cathartics.  They  are  very  active  agents  in  comparatively  small  medi- 
cinal doses,  and  many  of  them  are  poisonous  to  the  nervous  system  when 
given  in  large  doses.  Because  of  smallness  of  dose,  ready  solubility,  and 
the  fact  that  they  are  not  irritating  to  tissues,  as  a  rule,  most  of  their  salts 
may  be  used  hypodermically.  They  furnish  our  most  powerful  narcotics 
and  anodynes.  Two  especially,  morphine  and  cocaine,  present  the 
danger  of  drug  habit  through  unguarded  or  continued  use. 

The  pure  alkaloids,  as  a  rule,  are  nearly  insoluble  in  water,  but  their 
basic  character  permits  the  formation  of  salts  that  are  freely  soluble. 
Therefore,  almost  without  exception,  a  soluble  salt  of  the  alkaloid  is 
used  instead  of  the  simple  substance.  They  usually  represent  much  or 
all  of  the  activity  of  the  drugs  containing  them,  and  it  is  believed  that 
they  exist  in  the  drugs  only  in  combination  with  acids.  This  has  been 
proven  to  be  true  of  many  of  them,  e.  g.,  morphine  exists  in  opium  as 
meconate  of  morphine,  being  combined  with  meconic  acid;  strychnine 
is  combined  in  nux  vomica  with  igasuric  acid. 


36  DENTAL  MATERIA   MEDICA 


In  some  drugs  these  principles  are  very  numerous.  Opium  and 
cinchona,  for  instance,  each  yield  twenty  or  more  alkaloids. 

Artificial  Alkaloids.  Besides  the  large  number  of  alkaloids  existing 
naturally,  a  number  of  others  have  been  produced  artificially,  usually  by 
subjecting  a  natural  one  to  chemical  change.  Thus  apomorphine  has 
been  obtained  from  morphine,  and  homatropine  from  atropine.  Some 
of  these  artificial  bodies  are  valuable  additions  to  the  list,  as  they  are 
found  in  some  instances  to  have  an  action  quite  distinct  from  that  of 
the  original  alkaloid. 

Incompatibility.  In  prescribing  either  a  natural  or  an  artificial  alka- 
loid we  must  have  in  mind  their  incompatibility  with  certain  other  sub- 
stances, as  given  below: 

1.  With  Alkalies.  The  basic  power  of  the  alkaloids  is  exceeded  by  that 
of  the  ordinary  alkalies,  therefore  the  latter  easily  decompose  the  salts 
of  the  former.  Hence,  it  may  be  stated  that  alkaloidal  salts  in  solution 
are  incompatible  with  alkalies  and  alkaline  carbonates,  the  mixture  lead- 
ing to  precipitation  of  the  alkaloid.  The  danger  here  is  from  the  de- 
posited drug,  which  might  be  taken  in  poisonous  quantity  in  the  last 
one  or  two  doses  of  the  mixture. 

2.  With  Tannic  Acid.  Alkaloids  unite  with  tannic  acid  to  form  tan- 
nates,  which  are  insoluble;  therefore,  alkaloids  and  their  salts  in  solution 
are  incompatible  with  tannic  acid  or  with  any  preparation  containing  it, 
the  mixture  resulting  in  a  deposit  of  the  tannate  of  the  alkaloid. 

Note. — There  seems  to  be  a  contradiction  to  the  above  in  the  fact  that 
a  number  of  vegetable  drugs  contain  both  tannic  acid  and  alkaloids, 
without  any  precipitation  occurring  in  their  liquid  preparations.  The 
explanation  of  this  is  that  the  alkaloid  is  present  in  a  natural  combination, 
which  is  not  broken  up  by  the  peculiar  tannic  acid  that  is  its  natural 
associate  in  the  particular  drug. 

3.  With  Metallic  Salts.  Certain  metallic  salts,  especially  double  salts 
or  double  iodides,  cause  precipitation  when  mixed  with  alkaloidal  solu- 
tions.    Lugol's  solution  also  will  precipitate  the  salts  from  solution. 

Two  other  classes  of  chemical  bodies  belonging  to  the  group  of 
organic  bases,  but  which  are  in  no  sense  medicines,  should  be  mentioned 
here  because  of  their  relation  to  the  vegetable  alkaloids.  They  are 
ptomaines,  or  putrefactive  alkaloids,  which  are  basic  substances  pro- 
duced by  the  action  of  bacteria  upon  organic  matter,  and  leucomaines, 
which  are  basic  substances  resulting  from  normal  tissue  metabolism. 
The  former  are  of  special  interest  as  contributing  to  the  toxicity  of  many 
bacterial  diseases,  and  from  the  resemblance  of  certain  of  them  in  their 


DBUGS  AND  MEDICINES  37 

action  to  the  vegetable  alkaloids.  Thus,  tetanine,  present  in  the  dis- 
ease tetanus,  produces  the  characteristic  spasms  of  this  disease,  which 
resemble  closely  those  produced  by  strychnine.  Others  are  narcotic  in 
action,  bearing  some  resemblance  to  morphine  or  atropine, 

Glucosides.  This  class  comprises  those  vegetable  proximate  prin- 
ciples which,  when  decomposed  by  boiling  with  acids  or  alkalies,  or  by 
the  action  of  ferments,  yield  glucose,  with  some  other  product  peculiar 
to  the  substance  tested.  Some  have  the  chemical  behavior  of  acids, 
while  some  resemble  resins  in  nature. 

Neutral  principles  are  somewhat  similar,  but  have  neither  alkaline 
nor  acid  properties. 

These  two  classes  form  a  group,  some  members  of  which  are  of  great 
value  in  medicine.  Santonin,  aloin,  glycyrrhizin,  amygdalin,  digitalin, 
and  elaterin  furnish  examples.  While  their  uses  are  varied,  the  activity 
of  many  of  them  is  addressed  to  the  eliminative  functions.  Especially 
do  we  find  them  in  the  cathartic  drugs.  As  a  class  they  influence  the 
nervous  system  less  than  do  the  alkaloids,  and  they  are  less  poisonous. 


CHAPTER  II. 

REMEDIES:    THEIR  CLASSIFICATION  AND  DEFINITIONS. 

The  term  remedy  includes  any  agent,  of  whatever  character,  employed 
in  the  treatment  of  disease.  It  may  be  a  medicine  or  an  external  force 
or  influence.  It  may  be  intended  for  internal  administration,  for  external 
application,  or  for  less  direct  mental  influence.  Remedies  are  usually 
grouped  as  follows: 

Preventive  remedies,  those  that  are  employed  to  prevent  the  acquisi- 
tion, development,  or  propagation  of  disease,  e.g.,  vaccination  to  pre- 
vent smallpox,  and  disinfection  to  prevent  the  spread  of  any  infectious 
disease. 

Since  it  has  become  known  that  all  infectious  diseases  are  preventable, 
this  group  has  attained  a  rank  of  first  importance. 

Hygienic  remedies,  those  that  conduce  to  the  maintenance  of  health 
and  of  good  resistive  power  against  the  causes  of  disease.  They  include 
proper  food,  ventilation,  exercise,  bathing,  etc. 

This  group  is  closely  related  to  the  preceding  and,  on  the  whole, 
stands  next  to  it  in  importance,  it  being  a  sound  principle  that  such 
natural  means  of  correcting  diseased  conditions,  when  efficient,  should 
be  held  as  preferable  to  artificial  medicinal  or  mechanical  treatment. 

Mechanical  remedies,  those  that  involve  the  application  of  mechanical 
principles  or  appliances,  e.  g.,  restraint,  the  use  of  splints,  bandages  and 
surgical  instruments. 

Imponderable  remedies  include  forces  or  influences  that  are  not 
material  in  nature,  e.  g.,  heat,  electricity,  sunlight. 

Medicinal  or  pharmacologic  remedies,  the  substances  administered  or 
applied  in  the  treatment  of  disease.  They  are  intended  to  directly 
modify  functions,  or  to  antagonize  the  process  of  disease,  or  remove  its 
results.  They  are  known  as  medicines.  Being  material  in  nature,  they 
form  the  basis  of  pharmacology,  or  the  study  of  the  action  of  medicines. 

Our  classification  will  concern  this  group  chiefly,  and  will  be  based 
upon  action  and  uses,  rather  than  the  sources  of  the  various  substances. 
(38) 


REMEDIES 


39 


EEMEDIES 


Local  Eemedies  . 


General  Eemedies 


Classification  of  Remedies. 

Local. 
General 

Depletives. 

Eubefacients. 

Vesicants. 

Escharotics. 

Demulcents. 

Emollients. 

Astringents. 

Hemostatics. 

Detergents. 

Antacids  (alkalies). 

Antiseptics. 

Bleaching  agents. 

Analgesics. 


Stimulants  (tonics) 


Alteratives. 


Sedatives 


Antispasmodics. 


Eliminatives 


Antiseptics. 
Antitoxins. 
Digestants. 
Anthelmintics. 


Arterial  stimulants 

Nerve  stimulants 

Digestive  stimulants. 
r  Arterial  sedatives 


Nerve  sedatives 


Errhines. 
Sialagogues. 
Emetics. 
Expectorants. 
Diaphoretics. 
Diuretics- 
Cathartics. 


Diffusible. 

Cardiac. 

Vascular. 

Cerebral. 

Spinal. 

Vasomotor. 


Cardiac. 
Vascular. 


'  Anodynes. 
Hypnotics. 
Narcotics. 
Anesthetics. 
Antipyretics. 


DEFINITIONS. 

Local  Remedies. 

Depletive.    The  class  of  local  depletives  includes  the  various  means 
employed  to  abstract  blood  or  serum  from  an  inflamed  or  hyperemic 

area. 

Scarification,  leeching  and  cupping  are  the  common  means. 


40  DENTAL  MATERIA   MEDIO  A 

Rubefacient.     An  agent  that  produces  redness  of  the  skin. 

Vesicant  or  Epispastic.    An  agent  that  produces  a  Ulster. 

Escharotic  or  Caustic.    An  agent  that  destroys  tissue. 

The  terms  rubefacient,  vesicant  and  escharotic  may  represent  the 
different  degrees  of  action  of  the  same  agent  in  some  instances. 

Demulcent.  An  agent  that  protects  or  soothes  a  raw,  irritated  or 
inflamed  surface.  It  is  usually  an  oily,  mucilaginous  or  albuminous 
substance  that  directly  coats  over  the  surface,  but  it  may  be  an  agent 
that,  upon  a  mucous  surface,  stimulates  the  natural  secretion,  which 
itself  acts  as  a  demulcent. 

Emollient.    An  agent  that  softens  and  soothes  an  inflamed  part. 

Poultices  and  ointments  are  the  typical  emollients. 

Astringent.    An  agent  that  causes  contraction  of  tissue. 

Hemostatic.  An  agent  employed  to  arrest  hemorrhage.  Besides  the 
astringents,  thermal  and  mechanical  agencies  are  included. 

Detergent.    An  agent  used  to  cleanse  surfaces,  wounds  and  ulcers. 

Antacid.  An  agent  capable  of  neutralizing  acids,  by  reason  of  either 
its  alkaline  or  basic  property. 

Antiseptic  (Local).  An  agent  that  prevents  the  growth  and  propaga- 
tion of  septic  bacteria. 

Antiseptics,  germicides  and  disinfectants  form  a  related  group  which 
will  be  differentiated  in  connection  with  their  detailed  discussion. 

Bleaching  Agents  include  the  agents  and  means  employed  to  remove 
discoloration  of  tooth  structures. 

Analgesic.     An  agent  that  destroys  sensibility  to  pain. 

General  Remedies. 

Stimulant.  An  agent  that  increases  the  activity  of  an  organic  function 
or  process. 

The  action  of  stimulants  is  temporary  and  tends  to  exhaustion  of 
reserve  energy. 

Tonic.  An  agent  that  restores  one  or  more  lacking  elements  to  the 
tissues,  or  promotes  their  nutrition,  or  conserves  their  reserve  energy. 

Alterative.  An  agent  that  counteracts  a  morbid  state  of  tissue  by 
altering  in  a  favorable  manner  the  processes  of  nutrition.  The  action 
is  usually  obscure. 

Alteratives  become  intimately  associated  with  the  tissue  elements 
during  their  stay  in  the  system;  they  act  slowly  and  influence  nearly 
all  of  the  vital  processes. 


REMEDIES  41 

Sedative.  An  agent  that  diminishes  the  acti\'ity  of  an  organic  function 
or  process. 

Anodyne.     An  agent  that  reheves  pain. 

An  anodyne  may  depress  the  sensory  nerve  endings,  or  lessen  the 
conductivity  of  nerve  fibres,  or  diminish  the  receptivity  of  the  brain 
centres. 

Hypnotic.     An  agent  that  induces  sleep. 

Narcotic.     An  agent  that  produces  stupor. 

The  same  agent  may  be  anodyne  in  moderate  dose  and  narcotic  in 
large  dose. 

Anesthetic.     An  agent  that  abolishes  all  sensation. 

Antip3n:etic.  An  agent  that  causes  a  reduction  of  the  temperature  in 
fever. 

Antispasmodic.     An  agent  that  relieves  spasm  or  convulsion. 

There  is  no  distinct  class  of  antispasmodics.  The  term  simply 
describes  one  effect  of  medicines  that  may  be  stimulating  or  sedative 
in  their  general  action. 

Errhine  or  Sternutatory.  An  agent  that  increases  the  secretion  of  the 
nasal  mucous  membrane.  The  latter  term  refers  especially  to  agents 
that  cause  sneezing. 

Sialagogue  or  Ptyalagogue.  An  agent  that  increases  the  secretion  of 
saliva. 

Emetic.     An  agent  that  causes  evacuation  of  the  stomach. 

Expectorant.    An  agent  that  increases  the  secretion  of  the  air  passages. 

Diaphoretic  or  Sudorific.    An  agent  that  induces  sweating. 

Diuretic.    An  agent  that  increases  the  excretion  of  urine. 

Diuretics  may  act  through  the  circulation  by  increasing  arterial 
pressure  or  modifying  the  composition  of  the  blood,  or  by  directly  stimu- 
lating the  activity  of  the  kidneys. 

Cathartic.     An  agent  that  causes  evacuation  of  the  intestinal  tract. 

Antiseptic  (General).  An  agent  that,  being  absorbed,  renders  fluids 
or  tissues  of  the  body  destructive  of,  or  resistant  to  the  growth  of, 
bacteria  or  other  parasitic  bodies. 

Antitoxin.  A  serum  that  possesses  the  power  to  neutralize  the  toxic 
product  of  the  bacteria  of  some  particular  disease. 

Digestant.  An  agent  that  aids  the  solution  and  preparation  of  foods 
for  absorption. 

Anthelmintic.     An  agent  that  destroys  intestinal  parasites. 

The  same  agent  may  be  a  vermifuge,  the  latter  term  referring  to 
expulsion  of  the  parasites. 


CHAPTER   III. 

ADMINISTRATION  OF  MEDICINES. 

It  is  a  sound  principle  in  medicine  that  the  more  nearly  a  remedial 
substance  can  be  applied  to  the  point  of  disease,  the  more  effectual 
and  the  safer  is  its  use.  In  accordance  with  this,  our  remedies  should 
be  applied  locally  as  far  as  possible.  The  site  of  the  disease,  therefore, 
will  determine  in  very  many  cases  the  selection  of  the  site,  avenue  or 
method  of  application  of  a  medicine.  The  urgency  of  a  condition 
also  will  demand  a  choice  of  method,  as  an  emergency  often  calls  for 
the  most  rapid  administration  that  is  possible.  We  are  led  to  recognize 
various  avenues  and  methods  by  which  medicines  are  introduced  to 
the  system,  and  we  will  discuss  them  under  the  several  headings  here 
given. 

By  the  Stomach.  Stomach  or  mouth  administration  is  the  original 
and  common  method  employed  for  the  great  majority  of  medicines. 
As  the  stomach  and  intestine  constitute  the  natural  avenue  of  absorp- 
tion of  food  substances,  it  is  the  one  that  most  easily  provides  for  solu- 
tion and  absorption  of  a  medicine,  and  the  one  that  is  most  tolerant 
of  the  introduction  of  an  unusual  substance. 

A  very  soluble  drug  that  requires  only  a  small  dose  may  be  placed 
under  the  tongue,  and  absorption  follows  quickly.  Nitroglycerin 
given  in  this  way  will  produce  its  general  effect  within  three  minutes. 
It  is,  however,  a  very  diffusible  drug. 

Form  of  Medicine.  The  substance  employed  should  be  in  a  soluble 
condition,  or  in  solution,  if  intended  for  absorption  into  the  blood. 
For  local  effect  in  the  stomach  insoluble  medicines  are  frequently  used, 
e.  g.,  bismuth  subnitrate. 

The  reaction  of  the  gastric  juice  is  acid;  that  of  the  intestinal  juices 
is  alkaline.  Thus,  the  solution  of  any  substance  soluble  in  either  an 
acid  or  alkaline  fluid  is  aided,  and  we  find  that  practically  any  swallowed 
substance  that  is  even  slightly  soluble,  will  in  time  find  its  way  into  the 
fluids  of  the  body.  Solution  and  absorption  are  sometimes  aided  by 
chemical  change,  as  in  the  case  of  iron,  which  is  changed  to  chloride 
of  iron  by  union  with  the  hydrochloric  acid  of  the  gastric  juice.  Some 
(42) 


ADMINISTRATION  OF  MEDICINES  43 

substances  that  require  an  alkaline  liquid  to  dissolve  them  may  pass 
through  the  stomach  unchanged.  This  is  true  of  salol,  which  is  insol- 
uble either  in  water  or  in  an  acid  liquid.  It  reaches  the  small  intestine 
unchanged,  where  it  is  soon  decomposed  and  absorbed. 

Rapidity  of  Effect  depends  upon  solubility  and  rate  of  absorption. 
Quinine  sulphate  given  in  powder  form  will  require  considerable  time 
for  solution,  on  account  of  its  slight  solubility  except  in  the  presence 
of  a  free  acid.  It  will  probably  require  the  secretion  of  considerable 
gastric  juice  to  dissolve  a  full  dose  of  this  drug;  therefore,  when  given 
in  powder  an  hour  or  two  w411  elapse  before  the  effect  is  appreciated. 
The  same  drug  given  in  solution  will  produce  its  effect  much  sooner, 
particularly  if  it  be  given  when  the  stomach  is  empty.  The  rate  of 
absorption  from  the  stomach  depends  somewhat  upon  the  diffusibility 
of  the  medicine  used,  but  all  of  the  conditions  that  modify  osmosis 
have  their  influence;  the  activity  of  the  circulation,  the  state  of  blood 
pressure,  difference  in  specific  gravity  or  degree  of  salinity  between 
the  stomach  contents  and  the  blood,  and  the  physical  character  of  the 
substance  to  be  absorbed,  must  all  have  their  influence.  Fats  and  oils 
before  they  can  be  absorbed  require  to  be  saponified,  which  change 
occurs  after  they  pass  into  the  duodenum.  Therefore,  they  are  not 
absorbed  at  all  from  the  stomach. 

Among  all  of  the  above-named,  the  one  coTidition  modifying  the  rate 
of  absorption,  that  is  best  appreciated  and  most  easily  controlled,  is 
the  dilution  of  the  drug  by  the  stomach  contents  with  which  it  becomes 
mixed  and  which  must  be  absorbed  with  it.  Thus,  if  the  dose  be  given 
upon  an  empty  stomach,  with  only  sufficient  fluid  to  ensure  its  solution 
and  proper  dilution,  absorption  should  occur  quickly,  say  in  half  an 
hour;  while  the  same  dose  given  after  a  full  meal  would  require  three 
to  six  hours  for  complete  absorption,  because  of  its  diffusion  through 
one  to  two  quarts  of  stomach  contents  which  need  that  length  of  time 
for  absorption.  In  the  latter  case  only  a  part  of  the  dose  would  be 
taken  up  from  the  stomach,  as  the  contents  with  which  it  is  mixed 
passes  after  a  time  into  the  duodenum,  from  which  absorption  con- 
tinues. Indeed,  for  all  except  simple  solutions  the  small  intestine  is 
better  adapted  to  absorption  than  is  the  stomach,  but  rapidity  or  cer- 
tainty of  effect  will  be  best  secured  by  complete  absorption  during  the 
shorter  period  of  stomach  activity. 

It  follows  that,  in  order  to  produce  a  certain  degree  of  effect,  a  larger 
dose  will  be  needed  when  given  with  a  full  stomach  than  if  given  before 
a  meal,  for  the  degree  of  effect  depends  usually  upon  the  amount  of 


44  DENTAL  MATERIA  MEDIC  A 

the  drug  circulating  in  the  blood  at  one  time.  This  amount  will  be 
determined  by  the  quantity  absorbed  within  a  certain  period,  minus 
the  quantity  eliminated  during  the  same  period.  With  absorption 
slow  and  elimination  active  (the  elimination  of  some  drugs  begins  very 
quickly),  the  amount  present  in  the  blood  at  one  time  may  be  much 
less  than  the  amount  administered. 

As  a  rule,  then,  medicines  will  produce  their  effects  with  a  minimum 
dose  and  in  the  shortest  time  (one-half  to  one  hour)  when  given  with 
the  stomach  empty.  But  some  drugs  are  too  irritating  to  be  placed 
in  an  empty  stomach.  These  will  require  great  dilution.  This  is  true 
of  many  of  the  salts,  which  diffuse  easily,  as  a  rule,  and  may  be  given 
with  considerable  water.  Salts  as  irritating  as  the  bromides  and  iodides 
should  never  be  given  without  first  being  dissolved  and  well  diluted. 

When  rapidity  of  action  is  unimportant,  as  with  tonics  and  altera- 
tives, we  may  as  well  give  them  after  meals;  except  that  bitter  tonics, 
whose  action  is  a  local  one  upon  the  gastric  mucous  membrane,  should 
be  given  ten  or  fifteen  minutes  before  meals,  in  order  to  obtain  their 
best  effect.  Cathartics  are  commonly  given  at  bedtime  so  as  to  pro- 
duce their  effect  at  about  the  time  of  the  usual  morning  evacuation. 

Saline  cathartics  form  a  distinct  class  of  medicines  in  relation  to 
stomach  administration,  in  that  absorption  is  not  necessary  to  their 
action.  If  given  in  concentrated  solution  upon  an  empty  stomach 
their  high  degree  of  salinity  (high  osmotic  pressure)  will  determine  a 
flow  of  fluid  from  the  blood  into  the  digestive  tract  with  prompt  and 
copious  watery  evacuations.  They  are  best  given  in  the  morning  upon 
arising,  as  a  prompt  effect  from  a  smaller  dose  may  be  thus  obtained 
than  when  given  at  evening  after  a  meal. 

By  the  Bowel  (Rectum  and  Colon).  Whenever,  on  account  of 
inability  to  swallow  or  persistent  vomiting,  stomach  administration 
is  impossible,  medicines  or  food  may  be  introduced  into  the  lower 
bowel.  Also  for  local  medication  of  the  rectum  or  other  organs  located 
in  the  pelvis,  as  in  cases  of  dysentery  or  of  hemorrhoids,  this  method 
may  be  our  first  choice. 

Form  of  Medicine.  The  rectum  does  not  provide  for  solution  of  sub- 
stances to  any  degree.  Therefore,  if  our  object  be  general  medication 
we  must  ensure  solution  of  our  drug.  But  if  we  desire  local  medication 
only,  then  absorption  into  the  general  circulation  is  unnecessary,  and, 
indeed,  may  be  undesirable;  so  we  may  have  our  drug  in  a  condition 
to  be  taken  up  slowly  by  the  tissues,  the  action  being  correspondingly 
prolonged.    For  general  effect  a  non-irritating  solution  should  be  used 


ADMINISTRATION  OF  MEDICINES  45 

in  moderate  or  small  quantity,  so  that  it  may  not  be  expelled.  In  order 
to  favor  retention  and  absorption,  it  is  advantageous  to  place  the  dose 
high  up  in  the  colon.  This  can  be  done  vi^ith  a  patient  in  the  recum- 
bent posture,  by  raising  the  hips  above  the  level  of  the  head,  or  by 
introducing  a  flexible  rubber  tube  to  a  depth  beyond  the  sigmoid  flexure 
and  injecting  through  it.  For  local  effect  a  solution  or  suppository  may 
be  employed. 

Rapidity  of  Effect.  For  general  effect  the  action  of  a  medicine  by 
rectal  administration  is  slower  than  by  the  stomach;  but  with  condi- 
tions unequal — i.  e.,  comparing  absorption  from  a  full  stomach  with 
absorption  from  an  empty  rectum  we  may  have  a  more  rapid  effect 
from  the  rectum.  It  is  usually  held  to  be  true  that  the  drugs  which 
act  upon  the  nervous  system,  e.  g.,  narcotics,  may  be  given  in  a  much 
larger  dose  by  the  rectum  with  safety.*  This  may  be  due  partly  to 
slow  absorption  and  partly  to  the  distance  from  vital  centres  of  the 
site  of  absorption.  A  safe  rule  for  most  substances  seems  to  be  that 
the  dose  per  rectum  may  be  twice  the  dose  per  orem. 

By  the  Skin.  We  distinguish  several  methods  of  cutaneous  medi- 
cation as  follows: 

Epidermic,  where  a  substance  is  applied  to  the  superficial  epithelium, 
as  for  the  purpose  of  local  medication  or  of  counterirritation.  When 
a  systemic  effect  is  desired  a  similar  application  may  be  made,  with 
friction  added  in  order  to  secure  penetration  into  the  skin.  Thus 
mercurial  ointment 'is  very  commonly  employed  in  the  treatment  of 
syphilis.  The  term  inunction  is  applied  to  the  use  of  ointments  in  this 
way. 

Endermic,  an  obsolete  method,  which  consisted  in  first  raising  a 
blister,  then,  after  removal  of  the  epidermis,  in  sprinkling  a  medicine 
intended  for  absorption  upon  the  raw  surface. 

Hypodermic.  This  method  has  assumed  an  importance  which  places 
it  next  to  stomach  administration.  For  promptness  of  action  and 
definiteness  of  dose  it  is  superior  to  all  other  methods,  in  the  use  of 
those  drugs  which  admit  of  its  employment.  Also,  on  account  of  rapidity 
of  absorption,  the  dose  may  usually  be  about  one-half  of  the  dose  by 

*  Contrary  to  this,  it  is  sometimes  stated  that  strychnine  is  more  poisonous  when 
injected  into  the  rectum  than  when  swallowed.  (Potter's  Materia  Medica,  1901, 
p.  391 .)  It  is  true  that  a  drug  absorbed  from  the  lower  part  of  the  rectum  may  pass 
directly  into  the  internal  iliac  vein  and  reach  the  heart  and  general  circulation  with- 
out passing  through  the  liver,  which  organ  is  credited  with  the  power  of  lessening 
the  toxicity  of  many  poisonous  substances. 


46  DENTAL  MATERIA    MEDIC  A 

the  stomach.  The  method  consists  of  the  introduction  of  the  medicine 
into  the  subcutaneous  tissue  by  means  of  a  small  syringe  armed  with 
a  hollow  needle,  through  which  the  injection  occurs.  The  pain  of 
insertion  of  the  needle  deters  from  the  use  of  this  method  for  ordinary 
medication,  and  the  dangers  attending  the  injection,  though  slight, 
should  require  the  greatest  care  in  employing  it.  As  a  rule,  this  method 
will  find  its  place  in  meeting  the  following  conditions: 

1.  Inability  of  the  stomach  to  receive  or  retain  the  required  medicine. 

2.  Any  condition  requiring  the  immediate  action  of  a  medicine,  or 
absolute  certainty  of  dosage. 

3.  Inability  to  swallow,  as  when  unconscious,  or  after  local  injury. 

4.  Conditions  needing  local  medication,  as  in  the  employment  of 
cocaine.  In  dental  practice  the  injection  method  is  well  adapted  to 
the  need  of  securing  local  analgesia  in  many  cases  of  extraction.  A 
very  short  needle  is  here  employed  and  the  injection  is  submucous. 

The  hypodermic  and  submucous  injection  methods  are  limited  to 
the  use  of  soluble,  non-irritating  drugs.  Stimulation,  the  relief  of  severe 
pain  and  the  production  of  local  analgesia  comprise  the  common  indi- 
cations. The  freely  soluble  alkaloidal  salts  in  aqueous  solution  are 
well  adapted,  but  alcoholic  solutions  are  irritating.  Tinctures  are 
inferior  on  this  account,  but  they  may  be  used  in  emergency. 

The  dangers  attending  hypodermic  or  submucous  injection  are* 

1.  Septic  infection. 

2.  Injection  of  air  into  a  vein. 

3.  Injection  of  medicine  into  a  vein,  which  might  mean  an  overdose. 
Septic  injection  may  be  due  to  lack  of  sterilization  of  the  needle  or 

of  the  solution  employed.  The  result  is  usually  formation  of  abscess. 
To  avoid  this  danger  the  needle  and  syringe  should  be  sterilized  (by 
boiling  if  possible),  and  the  solution  be  in  boiled  or  distilled  water  and 
freshly  made. 

The  injection  of  air  into  a  vein  would  cause  interference  with  the 
circulation  through  the  lungs.  The  air,  being  carried  to  the  right  side 
of  the  heart,  would  be  beaten  up  with  the  blood  into  a  foam,  by  the 
action  of  the  tricuspid  valve.  The  air  bubbles  thus  formed  would  not 
pass  through  the  pulmonary  capillaries;  hence,  the  occurrence  of  em- 
barrassment which  might  be  serious,  the  condition  being  known  as 
air  embolism.  An  animal  may  easily  be  killed  by  injecting  a  moderate 
quantity  of  air  into  one  of  its  veins. 

To  avoid  this  danger  the  syringe  should  always,  before  injecting,  be 
held  with  the  needle  upward,  gently  tapped  so  as  to  dislodge  any  air 


ADMINISTRATION   OF  MEDICINES  47 

bubbles  within  and  cause  them  to  rise  toward  the  needle,  and  the 
plunger  then  gently  forced  onward  until  all  air  has  escaped  through 
the  needle.  The  presence  of  a  little  air  in  the  subcutaneous  tissue  would 
usually  be  harmless,  the  danger  being  in  the  possibility  of  puncturing 
a  small  vein  and  forcing  air  therein.  With  this  possibility  is  connected 
the  next  danger,  that  of  overdose  caused  by  throwing  the  whole  quantity 
of  the  drug  directly  into  the  venous  system.  Our  dose  is  intended 
for  gradual  absorption  into  the  blood  during  a  period  of  from  five  to 
fifteen  minutes.  If,  instead,  the  whole  dose  is  thrown  immediately 
into  the  blood  current  and  carried  to  the  central  nervous  system,  with- 
out the  possibility  of  free  dilution,  poisoning  may  quickly  occur.  To 
avoid  this  accident,  it  is  commonly  recommended  to  insert  the  needle 
deeply  enough  so  that  it  may  be  withdrawn  a  short  distance,  so  as  to 
escape  any  vein  that  might  have  been  punctured  in  its  course.  Another 
precaution  and,  in  the  writer's  opinion,  one  of  greater  certainty  is  to 
inject  slowly  and  note,  at  the  end  of  the  needle,  the  accumulation  of 
the  injected  fluid,  which  should  be  easily  felt  by  the  finger.  If  the  fluid 
disappears  about  as  rapidly  as  it  is  injected,  puncture  of  a  vein  should 
be  feared,  but  if  the  fluid  accumulates  with  the  injection,  so  that  a  dis- 
tinct swelling  is  felt  at  the  point  of  the  needle,  nothing  need  be  feared. 
With  the  injection  of  cocaine  into  the  gums  for  local  effect,  the  imme- 
diate blanching  of  the  tissue  about  the  point  of  the  needle  may  assure 
one  that  the  solution  has  diffused  into  the  tissues.  In  fact,  the  danger 
of  forcing  the  drug  into  a  vein  is  much  less  with  the  usual  submucous 
injection  than  with  the  hypodermic,  because  of  the  small  size  of  the 
veins  in  the  mucous  membrane  of  the  alveolar  region. 

The  Hypodermic  Syringe.  Many  kinds  of  syringes  are  on  the  market. 
The  older  style  of  glass  barrel  and  leather  plunger  syringe  has  the 
advantage  of  permitting  a  view  of  the  liquid  or  bubbles  of  air  within 
the  barrel,  but  the  disadvantage  of  being  less  easily  sterilized.  It  also 
dries  out  easily  unless  in  daily  use.  The  newer  style  of  all-metal  syringe 
has  the  disadvantage  of  allowing  no  view  of  the  interior,  but  it  has  the 
very  great  advantage  of  being  easily  sterilized  by  boiling  the  whole 
syringe.  With  either  kind  the  needles  may  be  sterilized  by  boiling, 
while  a  thorough  cleansing  of  the  syringe  with  boiled  water  after  each 
use  and  frequent  washing  with  5  per  cent,  carbolic  acid,  followed  by 
alcohol,  will  be  sufficient  care  of  the  syringe.  The  needle  should  be 
thoroughly  sterilized  before  each  injection. 

How  to  Give  a  Hypodermic  Injection.  Having  syringe,  needle  and 
solution  sterile,  the  skin  is  best  cleansed  by  first  scrubbing  with  soft 


48  DENTAL  MATERIA   MEDIC  A 

soap  and  water,  then  sterilizing  by  the  application  of  50  to  70  per  cent, 
alcohol,  5  per  cent,  solution  of  carbolic  acid,  oil  of  turpentine,  1 :  1000 
solution  of  bichloride  of  mercury,  or  some  other  equally  efficient  disin- 
fectant. The  hands  of  the  operator  should  be  similarly  treated.  Mak- 
ing sure  of  the  absence  of  air  from  the  syringe,  the  latter  is  held  firmly 
with  the  right  hand  while  the  thumb  and  first  finger  of  the  left  hand 
grasp  the  skin  and  raise  it  slightly  at  the  point  selected.  Into  the  promi- 
nence thus  occasioned  the  needle  should  be  cjuickly  pushed  in  a  direc- 
tion nearly  horizontal  to  the  surface,  and  should  penetrate  to  the  depth 
of  from  one-third  to  one-half  an  inch  or  even  more.  It  may  be  with- 
drawn slightly,  so  as  to  disengage  the  point,  after  which  the  injection 
is  made  slowly  so  as  to  avoid  too  great  violence  to  the  tissues  by  rapid 
distention,  which  may  be  painful.  Diffusion  and  absorption  may  then 
be  aided  by  gentle  rubbing  over  the  injected  area. 

The  site  of  injection  for  general  systemic  effect  may  be  upon  any 
accessible  portion  of  the  body,  care  being  taken  to  avoid  any  visible 
vein  or  the  proximity  of  an  artery  or  nerve  trunk;  but  in  case  of  col- 
lapse, when  the  circulation  and  activity  of  absorption  are  greatly  re- 
duced, the  injection  should  be  made  upon  the  trunk  rather  than  upon 
the  extremities — i.  e.,  nearer  the  centre  of  the  circulation,  so  as  to  secure 
more  rapid  absorption.  For  local  effect  the  site  of  injection  admits  of 
little  choice,  except  to  avoid  important  structures.  When,  however, 
the  injection  is  for  local  analgesia  the  medicine  is  injected  more  super- 
ficially, directly  into  and  beneath  the  skin  or  mucous  membrane,  the 
object  here  being  to  paralyze  the  sensory  nerve  endings,  which  are 
more  abundant  superficially.  It  is  unnecessary  to  penetrate  deeply 
into  the  tissue  unless  a  deep  operation  requires  it. 

A  word  of  caution  must  here  be  given  regarding  the  danger  of  form- 
ing the  habit  of  the  hypodermic  use  of  narcotics,  especially  morphine 
and  cocaine.  This  particular  method  of  drug  addiction  is  more  com- 
mon than  is  usually  known.  The  seductive  effect  of  the  drug  is  so 
quickly  induced  that  the  victim  readily  endures  the  slight  pain  of  the 
injection  for  the  sake  of  the  agreeable  result.  It  becomes  the  duty  of 
every  practitioner  to  guard  his  patient  and  emphatically  himself  against 
this  danger.  Self-administration  of  a  narcotic  in  this  way  is  an  exceed- 
ingly dangerous  practice  and  must  never  be  encouraged. 

Cataphoresis.  By  this  term  is  meant  the  introduction  of  drugs  in 
molecular  form  into  living  tissue,  by  means  of  the  galvanic  current. 
Analgesics  and  alteratives  may  be  employed  for  application  to  a  limited 
area  by  this  method.    The  positive  pole  applicator  is  saturated  with  a 


ADMINISTRATION   OF  MEDICINES  49 

strong  solution  of  the  drug  and  placed  directly  over  the  part  to  be  medi- 
cated, the  negative  pole  being  placed  indifferently  upon  the  cutaneous 
surface,  but  avoiding  the  more  sensitive  tissue  of  the  face.  The  drug 
is  carried  from  the  positive  pole  into  the  tissue. 

This  method,  with  cocaine  as  the  drug,  has  been  used  to  allay  sensi- 
tiveness of  dentine.  Care  must,  how^ever,  be  taken  not  to  disturb  the 
pulp  by  the  employment  of  a  strong  current:  5  to  10  volts  should 
be  the  maximum  strength  for  this  purpose  It  is  also  employed  to 
anesthetize  pulps  previous  to  immediate  extraction.  Further  uses  of 
cataphoresis  in  dentistry  are  to  carry  bleaching  agents  into  the  tubuli 
of  discolored  teeth  and  iodine  into  soft  tissues.  A  current  of  25  to 
40  volts  can  be  used  for  bleaching  purposes,  and  also  to  destroy  the 
pulp  of  a  tooth. 

It  has  been  recommended  to  cocainize  the  tissues  about  the  roots  of 
teeth  in  order  to  obtain  painless  extraction,  but  such  employment  of 
the  method  meets  v^^ith  little  practical  success. 

Intravenous  Injection.  In  case  of  emergency  it  sometimes  becomes 
necessary  to  inject  a  stimulating  or  restorative  agent  directly  into  a 
vein.  The  agent  mostly  used  at  present  by  this  method  is  normal  saline 
solution  at  the  temperature  of  the  blood.  This  is  a  solution  of  6  parts 
of  sodium  chloride  in  1000  of  sterile  v^^ater.  It  is  intended  to  corre- 
spond to  the  blood  serum  in  salinity,  and  it  is  used  to  substitute  the  latter 
v^henever  deficient,  as  after  severe  hemorrhage  or  in  collapse.  Medi- 
cines may  be  added  to  this  for  intravenous  use. 

Hypodermoclysis.  The  introduction  of  a  large  amount  of  normal 
saline  solution  is  most  commonly  accomplished  by  hypodermoclysis, 
or  injection  into  the  subcutaneous  cellular  tissue.  From  1  to  2  pints 
are  often  employed  once  or  twice  daily  for  a  number  of  days  in  succes- 
sion. The  indications  for  its  use  are  great  depression  from  acute  dis- 
ease, hemorrhage  and  loss  of  fluid  from  the  system  by  severe  diarrhea. 
The  apparatus  employed  consists  of  a  gravity-  or  fountain-syringe 
armed  with  a  large-sized  hypodermic  needle.  The  latter  is  introduced 
through  the  skin  of  the  selected  site,  usually  the  lumbar  region  or  under- 
neath the  breast,  and  the  fluid  is  allowed  to  flow  slowly  by  the  force  of 
gravity  into  the  loose  subcutaneous  tissue.  The  temperature  of  the 
solution  should  be  somewhat  higher  than  that  of  the  blood  so  as  to 
allow  for  cooling  during  the  slow  injection. 

By  the  Lungs  (Inhalation).  Only  gases,  vapors  and  finely  atomized 
liquids  may  be  employed  by  inhalation.  The  method  is  limited  to  the 
use  of  anesthetics,  stimulants,  antiseptics  and  a  few  volatile  antidotes. 


50  DENTAL   MATERIA   MEDIC  A 

Although  thus  hmited,  it  is  the  most  rapid  of  all  methods  of  medica- 
tion. The  great  extent  of  surface,  especially  adapted  for  the  absorption 
of  gases,  presented  in  the  expansion  of  the  pulmonary  tract  (estimated 
at  1000  to  1400  square  feet)  explains  why  the  action  of  an  inhaled  gas 
or  vapor  is  felt  almost  immediately.  The  method  is  adapted  especially 
to  general  anesthesia  where  a  rapid  and  profound  effect  is  needed. 
Without  this  method  general  anesthesia  would  be  impracticable,  for  it 
is  not  likely  that  sufficient  of  the  anesthetic  vapor  could  be  absorbed 
by  any  other  method  without  endangering  life  by  the  irritation  that  must 
follow  the  introduction  of  a  large  amount  of  ether  or  chloroform  in 
liquid  form. 

For  practical  use  by  inhalation  a  vapor  must  be  non-irritating,  except 
when  stimulation  is  desired.  Ammonia  is  frequently  applied  by  inhala- 
tion in  case  of  fainting,  in  order  to  stimulate  the  heart  and  respiration. 
It  is  irritating  to  the  mucous  membrane,  and  by  this  action  it  produces 
reflex  stimulation. 

For  the  purpose  of  local  medication  of  the  air  passages,  antiseptics 
and  sedatives  are  frequently  vaporized  in  connection  with  steam. 
Either  the  steam  atomizer  may  be  used,  or  the  drug  may  be  placed 
upon  boiling  water,  from  which  the  steam  is  inhaled.  The  most  irri- 
tating cough  may  frequently  be  relieved  by  proper  medication  with  this 
method,  while  even  in  pulmonary  tuberculosis  the  local  treatment  h^ 
inhalation  is  now  given  an  important  place. 


CHAPTEE    lY. 

MODES  OF  ACTION  OF  MEDICINES. 

The  precise  modes  of  action  of  all  drugs  upon  the  human  system  will 
probably  never  be  understood.  In  the  laboratory  many  medicines 
exhibit  certain  exact  physical  and  chemical  properties  that  are  constant; 
and,  while  a  knowledge  of  these  will  aid  us  very  much  in  studying  drug 
actions,  their  combination  with  biologic  factors  in  the  vital  structures 
of  the  body  brings  about  results  that  are  variable,  often  indefinable, 
and  peculiar  as  to  individuals. 

This  topic  will  not  be  discussed  in  theoretic  detail;  but  the  simpler 
and  better  understood  modes  of  action  can  be  profitably  illustrated 
by  examples,  if  we  are  careful  to  remember  that  any  explanation  can 
only  be  partial  in  most  cases,  because  the  contributory  vital  factors  so 
commonly  defy  our  scrutiny. 

The  simplest  kind  of  medicinal  action  would  seem  to  be  one  in  which 
'physical  properties  alone  are  concerned.  Glycerin  applied  to  a  denuded 
surface  or  to  a  sensitive  mucous  membrane  furnishes  an  example  of 
such,  its  action  being  simply  the  abstraction  of  water  from  the  tissues; 
but  we  must  also  note  a  secondary  effect  in  the  slight  irritation  which 
the  loss  of  water  occasions.  Alcohol  has  a  similar  action,  although  more 
irritating  because  of  its  stronger  affinity  for  water  accompanied  by 
coagulation  of  albuminous  matter.  The  irritation  continues  until  the 
abstracted  fluids  have  been  replaced  by  fluid  from  the  adjacent  tissues 
or  from  the  blood.  This  local  alteration  in  the  fluid  component  of  the 
tissues  exemplifies  a  principle  of  wide  application  throughout  the  body; 
for  as  glycerin  and  alcohol  abstract  small  amounts  of  water  locally,  so 
physical  factors  are  also  employed  in  the  withdrawal  of  large  cjuantities 
of  fluid  through  the  channels  of  elimination.  In  turn  the  fluid  of  the 
blood  is  restored  by  absorption  of  ingested  liquids  from  the  digestive 
tract  or  by  taking  up  a  certain  amount  from  the  tissues.  In  this  way 
waste  products  are  removed  from  the  cells  and  in  turn  they  receive 
fresh  nutritive  fluid  from  the  blood.  In  emergency  the  same  principle 
calls  for  the  hypodermic  injection  of  a  normal  saline  solution  in  quantity, 
in  order  to  supply  fluid  to  the  circulation,  as  after  a  severe  hemorrhage. 

(51) 


u. 


52  DENTAL  MATERIA   MEDIC  A 

In  the  treatment  of  nearly  every  disease  this  same  principle  finds  some 
application. 

Any  extensive  interchange  of  fluids  is  brought  about  chiefly  through 
the  influence  of  what  is  termed  salt  action,  i.  e.,  the  behavior  of  saline 
solutions  of  different  degrees  of  concentration  in  relation  to  the  salinity 
of  the  serum  of  the  blood,  by  which  a  flow  of  fluid  to  or  from  the  blood 
is  determined.  The  process  of  osmosis,  as  seen  in  the  passage  of  fluids 
of  different  composition  through  a  separating  animal  membrane,  is  the 
most  important  factor  of  salt  action.  Having  the  blood  serum  of  a  cer- 
tain concentration  within  the  vessels  and  a  saline  solution  more  concen- 
trated without,  the  osmotic  flow  will  be  from  the  blood  to  the  stronger 
solution,  because  of  the  higher  osmotic  pressure  of  the  latter;  on  the 
contrary,  a  weaker  solution  outside  of  the  bloodvessels,  because  of  its 
lower  osmotic  pressure,  will  readily  pass  into  the  blood.  Thus  the 
administration  of  a  concentrated  solution  of  a  saline  cathartic  will 
promptly  cause  a  flow  of  serum  from  the  blood  current  into  the  digestive 
tract  (exosmosis),  while  pure  water  taken  into  the  digestive  tract  will 
pass  into  the  bloodvessels   (endosmosis). 

A  single  drug,  potassium  bitartrate,  may  illustrate  both  exosmosis 
and  endosmosis :  P'or  if  it  be  given  in  form  of  the  salt  with  very  httle 
water  it  will  attract  a  large  quantity  of  water  from  the  blood  and  so 
induce  a  cathartic  effect;  but  if  it  be  given  in  dilute  solution,  it  will  pass 
into  the  blood  and  be  carried  to  the  kidneys  to  be  eliminated,  where  its 
action  will  be  diuretic.  Any  solution  that  is  indifferent  in  osmotic  action 
— i.  e.,  having  the  same  osmotic  pressure  as  the  blood  serum — is  called 
isotonic,  one  of  higher  osmotic  pressure  being  hyperisotonic  and  one 
of  lower  osmotic  pressure  being  hypoisotonic.  The  salinity  of  the  blood  is 
imitated  in  the  normal  (isotonic)  saline  solution,  containing  0.6-0.75  per 
cent,  of  sodium  chloride,  which  is  now  so  largely  used  as  a  restorative. 

Passing  from  the  purely  physical  influences,  we  recognize  also  the 
factor  of  electric  relations  in  the  action  of  many  substances.  It  has 
been  ascertained  that  certain  chemical  compounds,  when  in  dilute 
solution,  as  in  the  blood  and  tissues,  are  dissociated  into  ions  of  their 
elements  or  radicals  and  that  these  are  charged  with  positive  and  nega- 
tive electricity.  They  do  not  necessarily  act  as  the  pure  elements;  in 
fact,  they  often  exhibit  entirely  different  properties,  e.  g.,  in  the  dissocia- 
tion of  sodium  chloride,  the  chlorine,  which  in  its  free  state  is  a  poisonous 
gas,  does  not  act  as  such,  but  as  the  electronegative  chlorine  ion. 

In  the  complexity  of  action  of  many  of  the  chemical  compounds, 
however,  it  is  impossible  to  separate  the  physical,  electric  and  chemical 


Modes  oP  aCtIon  oP  MEbiGiNEB  53 

factors,  but  their  recognition  serves  to  explain  something  of  drug  action. 
The  separation  of  the  less  irritating  iodine  ion,  in  the  dissociation  of 
potassium  iodide,  gives  us  the  probable  reason  why  so  large  amount  of 
iodine  can  be  taken  in  this  combination  without  being  poisonous. 

The  chemical  features  of  drug  action  can  be  very  clearly  demon* 
strated  for  certain  substances  of  local  use.  In  the  tooth  structure  espe- 
cially, where  the  vital  factors  are  slight,  about  as  definite  chemical 
reactions  can  be  obtained  as  in  the  laboratory.  The  science  of  bleach- 
ing teeth  rests  upon  this  fact,  and  thorough  disinfection  by  chemical 
means  is  made  possible.  But  also  in  the  softer  structures  that  possess 
greater  vitality,  the  chemical  reactions  of  drugs  locally  applied  are  often 
very  evident,  e.g.,  the  coagulant  action  of  phenol  and  the  corrosive  action 
of  strong  acids  and  alkalies.  These  reactions  and  their  chemical  basis 
are  more  fully  discussed  in  the  chapter  on  Escharotics.  A  special  line 
of  medication  where  the  action  is  purely  chemical  is  the  application  of 
chemical  antidotes  in  cases  of  poisoning. 

In  the  use  of  simple  irritants  and  astringents  we  observe  some  of  the 
reactionary  effects  of  drugs.  These,  secondary  to  the  first  local  action, 
may  constitute  the  real  therapeutic  effect  desired.  When  we  speak  of 
irritation  we  mean  a  disturbance  of  tissue,  or  a  reaction  to  a  disturbance. 
Infiammatioii  is  a  reaction  of  higher  grade  having,  as  a  prominent  feature, 
a  great  increase  in  the  number  of  leukocytes  (leukocytosis),  which 
becomes  general  in  an  inflammation  of  any  severity.  This  condition 
really  represents  a  reactive  increase  in  the  protective  and  reparative 
resources  of  the  blood  and  tissues,  which  may  be  an  important  factor 
in  securing  relief.  The  action  of  an  irritant  drug  in  the  vicinity  of  an 
inflammation  (counterirritation)  is  believed  to  stimulate  absorption 
by  the  lymphatics  as  well  as  a  local  increase  of  leukocytes.  These 
observations  emphasize  the  vital  factor  which  aids  in  securing  the 
therapeutic  effect,  or  which  may  modify  that  effect,  or  even  influence 
the  primary  action  of  the  drug.  This  factor  is  so  variable  that  for  most 
medicines  the  sum  of  the  effects  can  only  be  learned  by  experience,  and 
even  then  individual  peculiarity  (idiosyncrasy)  may  determine  unex- 
pected results. 

Medicines  intended  for  general  systemic  effects  have  a  more  obscure 
action,  which  can  usually  be  judged  only  by  the  clinical  results  observed. 
In  general,  we  may  say  that  stimulants  and  sedatives  influence  functions 
chiefly  and  their  action  is  temporary;  while  alteratives  and  restorative 
tonics  influence  the  structure  of  tissues  by  entering  into  the  composition 
of  the  cells,  their  effects  being  accordingly  more  permanent.    Stimulants 


54  DENTAL  MATERIA  MEDIC  A 

may  irritate  tissue  primarily,  inducing  stimulation  reflexly,  or  they  may 
cause  more  rapid  or  more  powerful  discharges  of  energy  in  functional 
activity  of  the  organ  stimulated.  Sedatives  depress  functional  activity, 
usually  by  direct  influence  upon  nerve  tissue,  and  they  easily  cause 
poisoning  in  very  susceptible  persons.  A  more  detailed  discussion  of 
the  action  of  stimulants,  sedatives  and  alteratives  is  given  in  the  separate 
chapters  devoted  to  them. 

It  is  well  known  that  the  blood  possesses,  in  some  degree,  protective 
properties  against  certain  toxic  substances;  and  one  of  the  important 
developments  in  therapeutics  has  been  the  discovery  that  the  protective 
resources  may  be  increased  by  medication  of  a  peculiar  kind,  or  added 
to  artificially.  The  use  of  nuclein,  which  is  a  proteid  compound  with 
nucleic  acid,  obtained  from  animal  cells  or  from  the  yeast  plant,  stimu- 
lates leukocytosis,  which  constitutes  a  valuable  protective  factor. 

Again,  in  some  of  the  infectious  diseases  the  blood  reacts  to  the  toxic 
products  of  the  disease  and  develops  an  antitoxic  body,  which  neutral- 
izes the  poison  and  determines  recovery  in  favorable  cases.  This  fact 
is  made  use  of  in  the  treatment  of  diphtheria  and  tetanus  particularly. 
A  strong  antitoxin,  which  can  be  specific  for  the  one  disease  only,  is 
developed  in  the  blood  of  a  domestic  animal,  the  serum  of  which  is 
then  kept  in  a  preserved  state  for  use  when  needed.  In  the  event  of 
diphtheria  a  quantity  of  antidiphtheric  serum  is  injected  hypodermically 
as  early  as  possible,  with  the  result  commonly  that  the  poison  of  the 
disease  is  perfectly  neutralized.  Antitoxins,  being  natural  products 
of  the  blood,  are  harmless  and  may  be  used  in  strong  dosage.  The 
discovery  of  antitoxins  may  be  termed  a  revelation  of  one  of  nature's 
methods  of  antagonizing  disease,  and  it  has  opened  up  a  large  field  of 
investigation  which  bids  fair  to  yield  still  further  therapeutic  results. 


PART  II. 

LOCAL  REMEDIES. 


CHAPTER  Y. 

DEPLETIVES. 

Depletive  measures  are  those  employed  to  abstract  blood  or  serum 
from  an  inflamed  or  hyperemic  area,  usually  with  the  purpose  of  relieving 
pain  or  pressure.     The  indications  for  their  use  are: 

1.  Inflammation  that  is  painful  or  that  threatens  extension  or  destruc- 
tion of  tissue. 

2.  Passive  congestion  of  a  part,  that  interferes  with  its  function  or 
with  resolution  of  disease. 

3.  Simple  hyperemia,  when  its  continuance  is  likely  to  produce  serious 
disturbance  of  tissue  or  function, 

A  depletive  measure  need  not  always  remove  blood  or  serum  from  the 
body.    It  may  draw  it  from  the  point  of  disease  into  another  part. 

Dry  Cupping  consists  in  the  application,  to  the  surface  of  the  skin, 
of  glass  cups  from  which  the  air  has  been  exhausted.  An  alcohol  flame 
passed  quickly  into  the  cup  immediately  before  applying,  is  the  means 
commonly  employed  to  exhaust  the  air.  The  vacuum  permits  the 
skin  and  underlying  tissue  to  bulge  into  the  glass  and  to  become  con- 
gested with  blood.  In  this  way,  with  each  cup  nearly  or  quite  a  table- 
spoonful  of  fluid  may  be  drawn  into  the  skin  and  just  beneath  it.  With 
the  employment  of  a  number  of  cups  a  very  decided  influence  upon  a 
deeper-lying  inflammation  is  noticed,  but  no  fluid  is  removed  from  the 
body.  This  method  is  of  great  value  in  conditions  of  pulmonary  con- 
gestion or  pneumonia,  and  a  large  number  of  cups  may  be  applied, 
and  repeatedly,  to  the  surface  of  the  chest.  The  cups  cannot  be  applied 
upon  an  irregular  or  a  hard  convex  surface. 

Wet  Cupping  is  accomplished  by  first  scarifying  a  limited  surface 
with  an  ordinary  lancet,  or  with  the  especially  adapted  spring  lancet, 
then  applying  a  cup  as  in  dry  cupping.    The  vacuum  allows  a  free  flow 

(53) 


56  LOCAL  REMEDIES 

of  blood  into  the  cup.  By  this  method  a  considerable  quantity  of 
blood  may  be  abstracted  from  any  part  of  the  body. 

Scarification  with  a  lancet  is  the  method  of  depletion  most  commonly 
used  in  dental  practice.  The  indications  are  hyperemia,  inflammation, 
and  passive  congestion.  After  scarification,  bleeding  may  be  encouraged 
by  holding  warm  water  in  the  mouth,  while  cold  water  will  tend  to 
lessen  the  flow. 

The  precautions  to  be  observed  in  scarification  are:  strict  asepsis, 
guarding  against  too  extensive  a  wound  by  a  sudden  movement  on 
the  part  of  the  patient,  and  avoiding  the  proximity  of  vessels,  nerves, 
or  of  Steno's  duct  opposite  the  first  superior  molar. 

Lancing  of  the  gums  over  advancing  teeth  is  called  for  when  unusual 
hyperemia  or  swelling  is  present,  or  where  general  irritability,  fever, 
or  convulsions  point  to  a  local  irritation  which  is  found  in  an  abnormal 
eruption  of  the  teeth.  It  must  be  borne  in  mind,  however,  that  sources 
of  irritation  may  exist  in  other  parts  of  the  digestive  tract,  and  that  in  a 
dentition  which  is  progressing  normally  there  is  seldom  any  need  of 
scarifying  the  gums.  AMien  employed,  the  incision  should  be  directly 
over  the  advancing  margins  of  the  teeth. 

Leeching.  The  application  of  a  leech  (Hirudo  medicinalis)  is  a  con- 
venient and  efficient  means  of  abstracting  blood  from  a  local  point, 
for  the  relief  of  acute  inflammation  or  congestion.  For  use  in  the 
mouth  it  is  not  generally  applicable,  on  account  of  the  aversion,  on 
the  part  of  some  people,  to  having  a  leech  in  the  mouth.  Nevertheless, 
it  is  to  be  considered  among  the  best  means,  and  if  employed  with  a 
leech  tube  so  that  it  does  not  touch  the  tissue  except  by  its  sucker 
extremity,  the  objection  is  minimized.     The  leech  tube  is  of  glass,  of 


Fig.  1 


(T 


Leech  glass. 

a  proper  size  to  admit  the  leech  and  allow  its  distention  by  blood.  It 
is  drawn  to  a  narrow  opening  at  one  end.  This  smaller  opening 
should  be  large  enough  to  permit  the  passage  of  the  smaller  end  of  the 
leech,  by  which  it  makes  suction.  Swedish  leeches  are  mostly  employed 
on  account  of  their  large  size,  their  capacity  for  abstracting  blood  vary- 
ing from  one-half  to  two  fluidrachms  (2  to  8  c.c).  If  the  leech  does 
not  bite  readily  it  may  be  advisable  to  make  a  puncture  with  a  fine 


DEPLETIVES  57 

point  at  the  selected  place,  in  order  to  obtain  a  small  drop  of  blood 
upon  the  surface.    This  will  usually  induce  the  leech  to  bite. 

The  suction  may  be  interrupted  at  any  time  by  sprinkling  a  little 
salt  upon  the  leech,  when  it  will  drop  off.  The  bite  made  is  V-shaped 
and  clean  cut.  Bleeding  may  continue  for  some  time,  and  may  even 
require  the  use  of  strong  styptics  or  pressure  in  order  to  check  it.  When 
applied  to  the  skin  a  small  triangular  scar  invariably  remains  from 
the  leech's  bite;  therefore,  when  used  upon  the  face  or  neck,  the  point  of 
application  of  a  leech  should  be  where  the  scar  will  not  be  noticeable, 
as  under  the  chin,  behind  the  ear,  at  the  angle  of  the  eye  or  nose,  within 
the  hairy  region,  or  at  the  site  of  a  natural  wrinkle. 

As  applicable  to  all  means  of  local  bleeding  it  must  be  borne  in  mind 
that  the  hemorrhagic  diathesis  (hemophilia)  is  an  absolute  contraindica- 
tion to  their  employment. 

Venesection  or  Phlebotomy.  General  bloodletting  is  accomplished 
by  opening  a  vein  (usually  the  median  cephalic,  just  above  the  bend 
of  the  elbow).  This  therapeutic  measure  was  much  abused  in  earlier 
years,  and  the  natural  reaction  resulted  in  its  almost  complete  aban- 
donment. At  the  present  time,  however,  it  is  often  employed  as  an 
emergency  procedure,  in  cases  of  severe  toxemia  or  physical  embar- 
rassment of  the  circulation.  A  pint  or  more  of  blood  may  be  drawn. 
The  flow  is  easily  stopped  by  the  simple  pressure  of  the  dressing  applied. 

In  order  to  find  the  vein  readily  and  to  secure  its  distention  and  con- 
sequent free  flow  of  blood,  a  bandage  is  first  placed  around  the  arm 
just  below  the  shoulder  and  drawn  tightly  enough  to  obstruct  the 
venous  return,  but  not  to  interfere  with  the  arterial  flow.  This  causes  a 
fulness  of  the  vessels  of  the  arm  and  great  distention  of  the  veins.  The 
median  cephahc  is  then  exposed  with  aseptic  care  and  the  opening 
made  with  the  ordinary  sterile  lancet. 

General  Depletion  is  also  secured  by  means  of  sweating  or  by  free 
catharsis.  In  either  case  it  is  possible  to  withdraw  from  one  to  three 
pints  of  serum  from  the  circulation  within  a  short  time,  which  result 
may  be  a  considerable  factor  in  lessening  a  local  hyperemia  or  inflam- 
mation. Sweating  is  most  readily  induced  by  the  hot-air  bath,  taken 
either  sitting  (cabinet  bath)  or  lying  down  (hot-air  bed  bath).  The  hot 
mustard  foot  bath  also  is  efiicient,  adding  to  the  sweating  the  derivative 
rubefacient  effect  upon  the  lower  limbs. 

A  depleting  catharsis  is  secured  by  the  action  of  a  quickly  acting 
hydragogue,  such  as  jalap,  croton  oil,  and  the  saline  cathartics.  The 
sahnes  are  most  commonly  used.    When  given  in  concentrated  solution 


58  LOCAL  REMEDIES 

(hyperisotonic,  see  p.  52)  upon  an  empty  stomach,  they  act  promptly 
by  causing  a  copious  flow  of  serum  from  the  bloodvessels  into  the  diges- 
tive tract,  followed  by  evacuation  without  much  irritation.  The  state 
of  blood  pressure  modifies  their  activity  somewhat,  a  fulness  of  the  cir- 
culation favoring  an  outward  flow  of  serum.  A  low  blood  pressure 
would  require  salines  to  be  given  in  larger  quantity  for  the  same  desired 
result. 

The  vegetable  hydragogues  are,  as  a  rule,  more  violent  and  drastic 
in  action,  because  they  irritate  the  bowel  and  greatly  stimulate  peris- 
taltic action.  Jalap  is  milder  than  others,  and  very  efficient  when  sim- 
ple depletion  is  desired,  and  it  may  be  used  daily  for  some  time;  but  when 
a  revulsive  action  is  wanted  the  more  irritating  croton  oil  is  used. 

General  depletion,  as  above,  is  indicated  where  there  is  accumulation 
of  serum  in  a  serous  cavity,  as  the  pleural  or  peritoneal,  or  where  car- 
diac or  hepatic  disease  is  attended  with  marked  venous  congestion. 


CHAPTER   VI. 

COUNTERIRRITANTS. 

CouNTERiRRiTATiON  means  the  production  of  an  irritation  in  a 
normal  part  of  the  system  in  order  to  influence  a  diseased  part  favor- 
ably. The  irritant  is  usually  apphed  to  the  skin,  but  it  may  be  applied 
to  the  mucous  membrane  of  the  mouth  or  to  other  accessible  mucous 
surfaces.  The  action  varies  in  degree  from  a  simple  reddening  of  the 
skin,  by  increase  of  the  circulation  locally,  to  a  destruction  of  the  super- 
ficial layer  of  tissue.  According  to  the  degree  of  irritation  following 
their  application,  the  agents  are  divided  into: 

1.  Rubefacients,  agents  that  produce  redness  of  the  surface. 

2.  Vesicants  or  epis'pastics,  agents  that  irritate  sufficiently  to  cause 
an  exudate  of  serum  beneath  the  epidermis  (a  blister). 

3.  Escharotics,  caustics  or  corrosives,  agents  that  destroy  tissue. 
The  same  agent  may  be  a  rubefacient,  a  vesicant  or  a  caustic,  as 

determined  by  the  strength  and  duration  of  its  application.  '  This  may 
be  illustrated  by  the  application  of  heat  to  the  skin.  Moderate  heat 
will  cause  a  dilatation  of  the  cutaneous  bloodvessels,  with  a  decided 
hyperemia  (rubefacient  effect);  a  higher  degree  of  heat  will  determine 
the  escape  of  serum  from  the  engorged  vessels  to  the  extent  of  lifting 
up  the  non-vascular  epidermis  (vesicant  effect);  and  a  degree  of  heat 
that  will  burn  will  cause  destruction  of  the  skin  (escharotic  effect). 

Agents  will  be  selected,  therefore,  for  the  degree  of  effect  desired. 
While  some  of  them  will  produce  any  of  the  above  effects,  others 
are  more  limited  and  fall  naturally  into  only  one  class.  Thus,  arsenic 
acts  slowly,  and  it  cannot  be  said  to  produce  any  typical  effect  other 
than  escharotic;  capsicum  usually  produces  only  a  rubefacient  effect. 
It  must  be  noted,  however,  that  the  thickness  and  texture  of  the  skin 
will  cause  a  difference  in  effect,  from  the  same  application,  in  different 
individuals,  and  in  the  same  person  upon  different  parts  of  the  body. 
A  thin,  tender  skin  will  blister  much  more  easily  than  a  thick,  tough  one. 

It  must  also  be  noted  that  the  same  irritant  will  have  a  much  severer 
effect  upon  the  mucous  membrane  than  upon  the  skin,  on  account  of 
the  softer  and  looser  texture  of  the  former;  e.  g.,  tincture  of  iodine  by  a 

(59) 


60  LOCAL  REMEDIES 

single  application  will  only  irritate  the  skin  slightly,  but  it  will  quickly 
corrode  and  destroy  the  superficial  layer  of  a  mucous  membrane. 

The  severer  "degree  of  counterirritation  (i.  e.,  blistering)  should  be 
avoided  both  in  childhood  and  in  old  age,  because  of  the  greater  sus- 
ceptibility to  irritation  and  the  lower  vital  resistance  at  the  extremes 
of  life. 

Several  rules  may  be  vdsely  observed  as  to  the  site  of  application  of 
a  counterirritant  in  typical  conditions : 

1.  If  an  inflammation  is  quite  superficial,  the  counterirritant  should 
be  applied  at  a  short  distance.  If  applied  immediately  at  the  point  of 
inflammation,  the  latter  may  be  aggravated. 

2.  If  deep  inflammation  is  to  be  treated,  the  irritant  is  applied  directly 
over,  so  as  to  induce  a  flow  of  blood  to  the  surface  and  away  from  the 
deeper  point  of  disease. 

3.  In  case  of  neuralgia  or  neuritis,  the  irritant  may  be  applied  with 
best  effect  directly  over  the  origin  of  the  affected  nerve,  or  at  the  point 
of  its  emergence. 

4.  In  treating  affections  about  the  face  and  head,  the  irritant  may  be 
applied  back  of  the  ear,  beneath  the  chin  or  upon  the  back  of  the  neck. 

Modes  of  Action  of  Counterirritants.  The  remedial  effect  of  a  counter- 
irritant  is  probably  brought  about  by  a  threefold  action.  They  influ- 
ence, first,  the  circulation;  by  causing  a  hyperemia  at  the  point  of 
irritation,  the  tendency  of  the  blood  supply  will  be  in  that  direction 
and  away  from  the  original  disease;  second,  they  turn  the  attention  of 
the  system  toward  the  new  point  of  irritation  and  away  from  the  dis- 
ease, partly  a  mental  effect;  and  third,  they  influence  the  innervation 
of  the  diseased  part  by  the  reflex  influence  of  the  irritation.  In  the 
sum  of  their  effects  they  stimulate  the  movement  of  fluids  within  the 
tissues;  hence,  they  are  regarded  as  lymphatic  stimulants  and  are  often 
employed  to  stimulate  the  absorption  of  a  serous  or  inflammatory 
exudate. 

The  terms  derivative  and  revulsive  are  often  applied  to  the  action 
of  counterirritants,  the  latter  of  the  two  referring  especially  to  a  very 
decided  action,  as  in  the  prompt  and  violent  effect  of  croton  oil  as  a 
cathartic,  when  given  to  relieve  a  cerebral  condition. 

Heat.  This  agent  has  an  important  place  as  a  counterirritant, 
because  of  the  readiness  and  variety  of  forms  in  which  it  can  be  applied. 
The  hot-water  bag,  dry  and  moist  poultices,  hot  foot  and  sitz  baths, 
the  hot  irou;,  the  thermocautery  and  the  galvanocautery,  indicate  the 
range  of  methods  and  effects  that  attach  to  the  use  of  heat. 


COUNTERIRRITAXTS  61 

The  irritant  drugs,  other  than  escharotics,  are  here  discussed  in  the 
order  of  their  severity,  beginning  with  the  mildest.  Escharotics  are 
considered  in  a  separate  chapter. 

Capsicum.  Cayenne  Pepper.  The  fruit  of  Capsicum  fastigiatum. 
(For  preparations  and  doses,  see  Index  of  Drugs.) 

The  most  irritating  preparation  of  capsicum  is  the  oleoresin,  which 
is  seldom  employed  undiluted.  The  tincture  may  be  applied  to  the 
mucous  membrane  in  sluggish  or  atonic  conditions.  It  acts  by  irri- 
tating, and  thereby  inducing  a  more  active  local  circulation.  Diluted 
with  water,  it  may  be  used  as  a  wash  or  gargle.  The  official  plaster 
is  prepared  by  spreading  the  oleoresin  upon  resin  plaster.  It  is  used 
as  a  counterirritant  to  the  skin  or,  in  a  limited  area,  to  the  gums,  as 
in  the  beginning  of  pericementitis.  The  powdered  drug  is  like\sdse 
recommended  as  a  dental  counterirritant.  To  limit  and  concentrate  its 
action  it  must  be  enclosed  in  a  small  sack,  and  in  this  way  it  may  be 
combined  ^dth  other  drugs  if  desired. 

The  drug  and  its  preparations  are  capable  of  causing  irritant  poison- 
ings if  taken  internally  in  large  doses. 
v/Sinapis  Alba.    White  Mustard.    The  seed  of  Sina'pis  alba. 

Sinapis  Nigra.  Black  ]Mustard.  The  seed  of  Brassica  nigra.  (For 
preparations  and  doses,  see  Index  of  Drugs.) 

The  commercial  powdered  mustard  is  a  ground  mixture  of  white 
and  black  seed.  The  black  is  the  more  powerful.  IMustard  in  a  dry 
state  is  not  irritating,  but  the  black  mustard  seed  contains  two  sub- 
stances, sinigrin  and  myrosin,  which,  in  the  presence  of  water,  react 
to  form  the  very  irritating  volatile  oil  {oleum  sinapis  volatile).  Myrosin 
in  aqueous  solution  coagulates  at  140°  F.  (60°  C);  therefore,  a  tem- 
perature of  that  degree  or  higher  will  prevent  the  development  of  the 
volatile  oil.  Alcohol  and  acids  also  interfere  with  its  production.  Water 
at  ordinary  temperature  or  colder  is  the  agent  to  use  to  develop  the 
valuable  constituent  of  the  drug. 

Taken  internally  mustard  is  an  excellent  emetic,  the  effect  being  due 
to  its  irritation  of  the  stomach.  In  case  of  poisoning  by  opium  or  arsenic, 
or,  in  fact,  by  any  except  the  most  irritant  poisons,  if  the  case  is  seen 
early  while  the  poison  is  still  in  the  stomach,  a  tablespoonful  of  mustard 
stirred  up  in  a  glass  of  water  and  taken  at  once  is  a  most  efficient 
emetic.  Mixed  with  enough  water  to  form  a  paste,  mustard  is  applied 
between  two  layers  of  muslin  to  produce  quick  and  moderate  counter- 
irritation,  which,  if  prolonged,  may  proceed  to  vesication.  For  a  con- 
tinued rubefacient  effect,  the  mustard  may  be  diluted  by  mixing  with 


62  LOCAL   REMEDIES 

half  as  much  flour  before  adding  water.  A  mustard  plaster  or  poultice 
thus  prepared  is  called  a  sinapism. 

The  irritant  power  of  this  drug  makes  it  a  valuable  addition  to  the 
hot  foot  bath.  Here  the  mustard  is  to  be  stirred  up  in  cold  water,  and 
the  mixture  allowed  to  stand  for  several  minutes,  then  added  to  the 
hot  water  for  the  bath.  In  the  treatment  of  pericementitis  or  other 
active  inflammation  in  the  upper  part  of  the  body,  the  hot  mustard 
foot  bath,  carried  to  the  point  of  thorough  relaxation  and  sweating,  is 
a  valuable  general  measure.  In  similar  conditions  of  inflammation 
about  the  face  or  mouth  a  mustard  plaster  may  be  applied  to  the  back 
of  the  neck.  A  preparation  of  some  value  to  the  dentist  is  mustard 
paper  (charta  sinapis),  in  which  powered  black  mustard,  freed  from 
fixed  oil  by  percolation  with  benzin,  is  mixed  with  a  solution  of  india- 
rubber,  and  spread  upon  paper.  Protected  from  moisture,  mustard 
paper  will  keep  indefinitely,  and  it  may  be  found  at  any  time  ready 
prepared  in  the  stores.  For  local  blistering  of  the  mucous  membrane 
in  the  treatment  of  pericementitis,  it  is  cut  into  small  squares  or  other 
suitable  shapes  and  applied  directly  to  the  gum  over  an  offending  tooth. 
The  moisture  of  the  mouth  will  cause  the  volatile  oil  to  develop  quicldy. 
It  is  very  convenient  also  for  more  extensive  irritation  upon  the  surface 
of  the  body. 

Volatile  oil  of  mustard  may  be  used  as  an  irritant,  by  being  applied 
pure  for  limited  effect,  or  diluted  with  alcohol  for  extensive  effect. 

Oleum  Terebinthinse.  Oil  of  Turpentine.  The  volatile  oil  distilled 
from  turpentine.  (For  preparations  of  terebinthina  and  doses,  see 
Index  of  Drugs.) 

Crude  turpentine  is  the  solid  oleoresin,  or  pitch,  which  exudes  from 
the  pine  tree  when  the  bark  is  cut.  By  distillation  it  is  separated  into 
the  volatile  oil  of  turpentine  and  a  solid  residue  called  resin  or  rosin. 
The  oil  is  colorless,  with  a  characteristic  odor  and  taste,  which  become 
stronger  and  less  pleasant  with  age  and  exposure  to  air.  It  is  soluble 
in  3  parts  of  alcohol  and  in  1  part  of  glacial  acetic  acid.  For  internal 
use  the  rectified  oil  is  preferred.  It  is  neutral,  while  the  commercial 
oil  may  be  slightly  acid. 

Oil  of  turpentine  is  used  mostly  as  a  rubefacient  over  a  large  surface, 
as  upon  the  abdomen  or  front  or  back  of  the  chest.  It  may  blister 
if  used  full  strength.  The  official  liniment  (35  per  cent.)  may  be  used, 
or  a  turpentine  stupe  employed.  The  latter  is  prepared  by  wringing 
a  piece  of  flannel,  about  twelve  inches  square,  out  of  very  hot  water, 
then  distributing  from  ten  to  thirty  drops  of  oil  of  turpentine  upon  it. 


COUNTERIRRITANTS  63 

It  is  then  quickly  spread  out,  while  still  hot,  upon  the  surface  to  be 
treated,  and  covered  with  several  layers  of  fabric.  This  may  be  renewed 
frequently  so  as  to  keep  up  a  constant  rubefacient  action. 

This  drug  is  a  useful  general  antiseptic,  and  it  may  be  used  to  cleanse 
instruments  or  disinfect  the  skin,  but  the  odor  is  objectionable  to  some. 
It  has  been  employed  as  a  local  antiseptic,  but  there  is  little  use  for  it 
in  that  capacity  in  dental  practice  at  the  present  time.  It  does  not 
coagulate  albumin,  so  that  except  for  its  unpleasant  odor  it  might  be 
an  excellent  penetrating  antiseptic. 

In  poisoning  by  phosphorus  this  drug  has  long  been  regarded  as  a 
valuable  chemical  antidote,  if  administered  while  the  poison  is  still 
within  the  digestive  tract;  but  this  is  true  only  of  an  old,  highly  ozonized 
oil,  the  old,  French  oil  being  most  valuable  =  Fresh  oil  of  turpentine 
will  dissolve  phosphorus  and  must,  therefore,  be  avoided. 

Incom'patihility .  Oil  of  turpentine  will  react  violently  with  bromine 
or  powdered  iodine,  and  in  contact  with  a  mixture  of  nitric  and  sul- 
phuric  acids  it  will  ignite. 

lodum.  Iodine.  [L]  A  solid  non-metallic  element,  found  in  sea-weeds 
and  in  natural  mineral  compounds,  its  chief  commercial  source  being 
sodium  iodate,  obtained  in  Chili.  (For  preparations  and  doses,  see 
Index  of  Drugs.) 

Pure  iodine  occurs  in  bluish-black,  rhombic  plates,  having  a  penetrat- 
ing odor  and  sharp  taste.  It  is  slowly  volatile,  soluble  in  10  parts  of 
alcohol,  and  freely  in  ether;  also  soluble  in  an  aqueous  solution  of 
potassium  iodide  and  in  glycerin,  although  nearly  insoluble  in  water.* 
These  solutions  are  brown  in  color,  while  chloroform  and  carbon 
disulphide  each  dissolve  it  with  a  violet  color. 

Iodine  in  the  form  of  the  tincture  (7  per  cent.)  is  an  irritant  of  great 
value,  as  applied  either  to  the  skin  or  mucous  membrane.  Upon  the 
latter  it  should  be  used  only  to  a  limited  extent,  as  it  will  quickly  corrode 
the  superficial  layer.  As  a  counterirritant  to  the  gum  in  pericementitis, 
or  irritated  or  inflamed  pulp,  it  is  invaluable.  Iodine  is  a  penetrating 
agent,  although  the  alcohol  in  the  tincture  will  coagulate  albumin  some- 
what. In  common  with  other  irritants  it  has  the  power  to  stimulate 
absorption  by  the  lymphatics,  which  is  regarded  as  a  valuable  part  of 
its  local  action.     The  great  advantages  possessed  by  the  tincture  are 

*  Iodine  is  soluble  in  about  5000  parts  of  water  by  weight.  According  to  the 
U.  S.  Dispensatory,  eighteenth  edition,  its  solubiHty  in  water  may  be  increased,  not 
only  by  potassium  iodide,  but  by  sodium  chloride,  amrhonium  nitrate  and,  to  some 
degree,  by  tannic  acid. 


g4  LOCAL  REMEDIES 

promptness  and  limitation  of  its  action.  The  alcohol  coagulates 
the  tissue,  thus  limiting  action,  and  the  excess  evaporates  quickly, 
leaving  a  dry  surface.  Where  coagulation  is  a  disadvantage,  or 
where  the  action  of  alcohol  is  not  desired,  the  compound  solution 
may  be  used,  but  it  is  slightly  weaker  than  the  ordinary  tincture. 
Churchill's  tincture  (N,  F.),*  which  is  much  stronger  than  the  official 
tincture,  is  used  by  some.  It  contains  16.5  per  cent,  of  iodine  and 
3.3  per  cent,  of  potassium  iodide  to  aid  its  solution.  It  is  too  irritating 
for  application  to  the  mucous  membrane.  The  favorite  combination 
of  equal  parts  of  tincture  of  iodine  and  tincture  of  aconite  may  be 
used  more  freely,  as  in  it  the  iodine  becomes  diluted  and  its  irritant 
action  counteracted  somewhat  by  the  aconite,  which  is  a  local  seda- 
tive, f  The  brown  stain  produced  by  iodine  makes  it  objectionable 
to  use  upon  a  visible  surface,  and  it  should  never  be  used  within  a 
tooth,  for  fear  of  permanent  staining  of  the  dentine. 

As  an  antiseptic  and  disinfectant,  iodine  is  very  efficient.  It  may 
be  applied  in  strong  solution  to  ulcers,  but  is  quite  painful.  For  cleans- 
ing abscess  cavities  the  tincture  or  the  compound  solution  may  be 
used  somewhat  diluted,  either  applied  upon  cotton  or  injected  care- 
fully. It  may  also  be  carried  into  the  tissues  by  cataphoresis,  by  which 
method  it  is  very  useful  in  treating  pericementitis,  pericemental  abscess, 
and  especially  the  affections  of  the  pericementum  that  follow  influenza 
(Hofheinz). 

*  This  differs  from  Churrhiirs  iodine  caustic  {Liquor  lodi  Causticus,  N.  F.), 
which  has  the  following  formula: 


-M. 


-:m. 

Note. — Boulton's  solution  {Liquor  lodi  Carholatus,  N.  F.)  is  a  time-honored  and 
generally  useful  combination  of  iodine  and  phenol,  much  weaker  than  the  official 
preparations  of  iodine.     Its  formula  is: 

Gm.  or  c.c. 

R. — Tincturte  iodi  compositse,  151 

Phenolis  (liquefied  by  heat),  55 

Glycerini,  165; 

AquE3e,                                               q.  s.  ad  1000      — M. 
Expose  to  sunlight  until  it  has  become  colorless. 


Gm.  or  c.c. 

R  .—lodi, 

25 

Potassii  iodidi, 

50 

AquEe, 

100 

J  A  very  useful  formula  is: 

R. — Tincturse  iodi, 

Tincturae  aconiti, 

aa 

fsij  (Gm.  60) 

Chloroformi, 

f3j    (Gm.  4) 

CO  UNTERIBBITANTS 


65 


In  selecting  an  iodine  solution  for  use  we  should  have  in  mind  the 
distinctive  qualities  of  each,  as  given  below,  for  the  three  preparations 
most  commonly  employed: 


1.  Tincture  of  iodine,  7  % 


2.  Compoiind  solution  of 

iodine,  5  %  (Lugol's 
solution).* 

3.  Equal  parts  of  tincture 

of   iodine   and   tinc- 
ture of  aconite. 


Comparative  action  upon 
mucous  membrane. 


Mixed  witii  albumin. 


Most  severe  irritant;  cor- 
rodes mucous  mem- 
brane superficially  and 
promptly. 

Moderate  irritant;  does 
not  corrode. 


Moderate  irritant ;  cor- 
rodes more  slowly  than 
tincture  of  iodine  alone, 
and  sometimes  only 
after  several  applica- 
tions. 


Immediate  coagulation  due 
chiefly  to  the  alcohol 
present. 


Coagulation      slight, 
slowly  produced. 


and 


Immediate  coagulation  due 
chiefly  to  the  alcohol 
present. 


The  tincture  may  be  combined  with  carbolic  acid,  which,  \\dth 
full  strength  of  each,  increases  the  corrosive  and  coagulating  action. 
Equal  parts,  or  any  desired  variation  from  this,  may  be  used.  Such 
mixture  diluted  with  alcohol  or  glycerin  is  a  proper  application  to 
abscess  cavities,  ulcers,  unhealthy  gums  in  stomatitis,  etc.,  as  it  "wdll 
combine  disinfectant,  irritant  and,  indirectly,  stimulant  properties. 
When  properly  diluted  the  carbolic  acid  may  contribute  a  local  seda- 
tive effect. 

Water  can  be  used  to  dilute  the  official  tincture,  as  the  formula  now 
includes  5  per  cent,  of  potassium  iodide,  which  will  hold  the  iodine  in 
solution.  Therefore,  water  can  be  added  in  any  proportion  without 
precipitation  of  iodine,  which  is  a  great  advantage  in  some  of  the  uses  of 
the  tincture.  Iodine  has  a  reputation  as  a  stimulant  to  absorption  by 
the  lymphatics,  in  common  with  almost  all  counterirritants  and  altera- 
tives, with  the  advantage  that  it  belongs  to  both  of  these  classes.  To 
influence  the  absorption  of  indolent  swellings  or  to  reduce  enlarged 
lymph  nodes,  either  the  tincture  or  Lugol's  solution  may  be  applied 
(the   tincture  possessing   the  very  great  advantage  of   drying  quickly), 

*  The  formula  of   Lugol's  solution,  Liquor  lodi  Compositus,  is: 
I^.— lodi,  Gm.       5 

Potassii  iodidi,  10 

Aquae  destillatse,  q.  s.  ad         100|     — M. 

The  potassium  iodide  is  needed  to  hold  the  iodine  in  solution. 

5 


66  LOCAL  REMEDIES 

although  after  a  number  of  appKcations  the  skin  becomes  blistered  or 
broken,  when  their  use  becomes  very  painful.  A  better  preparation 
for  continued  use  is  the  ointment  (containing  4  per  cent,  iodine  and 
4  per  cent,  potassium  iodide),  which  may  be  applied  daily,  with  friction 
to  aid  absorption. 

Decolorized  tincture  of  iodine,*  so  called,  is  less  irritating  and  less 
efficient  that  the  other  solutions,  but  it  may  be  applied  where  the  color 
of  the  latter  would  forbid  their  use.  It  does  not  dry  readily  upon  the 
skin,  which  is  an  objection  to  its  employment. 

In  poisoning  by  iodine  the  proper  chemical  antidote  is  starch,  pre- 
ferably in  the  form  of  starch  paste.    This  should  be  given  freely. 

Incompatibility.  Free  iodine  is  incompatible  with  starch,  forming 
the  blue  iodized  starch;  with  oil  of  turpentine,  mixture  with  which  may 
be  followed  by  violent  reaction. 

Internally  the  drug  is  used  mostly  in  the  form  of  iodides,  for  the 
reason  that  these  salts  are  much  less  irritating  and  therefore  permit 
a  much  larger  quantity  of  iodine  to  be  taken.  As  an  alterative  it  will 
be  further  discussed  in  the  chapter  devoted  to  that  class  of  remedies. 

Oleum  Tiglii.  Croton  Oil.  A  fixed  oil  expressed  from  the  seed  of 
Croton  tiglium,  a  small  tree  indigenous  in  India.  A  brownish-yellow 
oil,  soluble  in  60  parts  of  alcohol,  becoming  darker  and  more  soluble 
with  age.     It  has  an  unpleasant,  fatty  odor  and  an  acrid  taste. 

Croton  oil  is  an  irritant,  whether  applied  to  the  skin  or  taken  inter- 
nally. When  rubbed  into  the  skin  it  acts  slowly,  producing  in  from 
twelve  to  twenty-four  hours  a  crop  of  small  vesicles,  which  are  distinct 
and  separated  from  each  other.  If  undisturbed,  these  dry  without 
breaking.  The  counterirritant  effect  is  pronounced,  with  much  less 
discomfort  than  from  cantharides.  The  drug  may  be  applied  back 
of  the  ear  in  treatment  of  severe  or  chronic  inflammations  about  the 
face  or  mouth.  It  should  be  rubbed  well  into  the  skin.  It  may  be 
mixed  with  equal  parts  of  tincture  of  iodine  for  combined  effect,  but 
about  the  head  it  will  generally  be  used  alone. 

Internally  the  oil  is  a  drastic  cathartic,  poisonous  in  very  moderate 
quantity,  thirty  minims  (2  c.c.)  having  caused  death.  In  the  usual 
dose  of  one-half  to  two  minims  (0.03-0.12  gm.)  it  irritates  the  intestinal 
tract,  producing  purging  in  from  one-half  to  two  hours.  On  account 
of  its  prompt  action  it  is  often  given  for  revulsive  effect  in  cases  of 

*  Tinctura  lodi  Decolorata  (N.  F.)  is  prepared  with  the  aid  of  sodium  hyposul- 
phite and  stronger  water  of  ammonia.  Because  of  the  chemical  change  attending 
the  decolorization,  it  contains  no  free  iodine,  but  is  a  variable  mixture  containing 
chiefly  ammonium  iodide. 


COUNTERIRRITANTS  67 

cerebral  hemorrhage  or  inflammation,  and  in  uremic  poisoning.  Care 
must  be  taken  in  handling  croton  oil,  and  it  should  never  be  tasted. 

Cantharis.  Cantharides.  (Spanish  Flies.)  The  dried  insect,  Can- 
tharis  vesicatoria.  Obtained  in  various  European  countries,  the  large 
Russian  flies  being  preferred.  (For  preparations  and  doses,  see  Index 
of  Drugs.) 

As  a  counterirritant,  cantharis  is  used  in  the  form  of  the  cerate, 
applied  as  a  plaster  to  the  skin,  or  the  cantharidal  collodion,  which 
is  applied  as  a  varnish. 

The  cerate  produces  in  about  twelve  hours  a  single  blister,  the  full 
size  of  the  application,  painful,  and  giving  a  maximum  of  counter- 
irritant  effect.  Seldom  should  a  space  larger  than  one  by  three  inches 
be  covered.  Either  the  surface  of  the  plaster  or  the  skin  should  be 
oiled  before  applying,  to  ensure  activity  of  the  irritant  principle  can- 
tharidin,  which  is  soluble  in  oils. 

The  cantharidal  collodion  may  be  used  instead  of  the  cerate  for 
ordinary  application.  It  is  believed  to  be  safer,  and  it  is  much  more 
convenient.  It  is  applied  as  any  other  collodion,  dries  quickly,  and 
requires  no  dressing  until  the  blister  is  formed. 

There  is  some  danger  of  absorption  of  the  active  principle,  can- 
tharidin,  to  avoid  which  the  application  should  be  as  limited  as  pos- 
sible. Irritation  of  the  genitourinary  tract  will  be  the  first  symptom 
of  its  poisonous  general  effect.  The  drug  is  reputed  to  be  aphrodisiac 
in  effect,  but  any  sexual  stimulation  is  due  to  irritation  and  is  only  one 
symptom  of  general  poisoning,  for  cantharis  is  an  irritant  poison  if 
taken  internally  in  excessive  dose.  The  tincture  is  the  preparation 
for  internal  use,  but  it  is  seldom  employed. 

In  case  of  poisoning  by  the  drug  in  bulk,  or  by  the  cerate,  no  oil 
should  be  used  as  a  demulcent,  because  of  the  solubility  of  the  active 
principle  in  oils. 

Oreosotum.  Creosote.  A  mixture  of  phenols  obtained  by  the 
distillation  of  wood-tar,  preferably  from  beech  wood. 

Creosote  is  irritant  rather  than  corrosive.  Formerly  it  was  not  easily 
obtained  pure  in  commerce,  having  been  commonly  adulterated  with 
carbolic  acid.  It,  therefore,  usually  possessed  the  qualities  of  that 
substance.  At  the  present  time  it  is  produced  more  extensively,  and 
pure  creosote  can  easily  be  had.  It  is  less  poisonous  than  was  formerly 
supposed,  and  can  be  taken  internally  in  quite  large  quantities  if  well 
diluted  (as  much  as  1  fluidrachm  (4  c.c.)  daily  has  been  administered). 
Applied  to  the  mucous  membrane  in  full  strength,  it  is  very  irritating,  but 


gg  LOCAL  REMEDIES 

not  strictly  corrosive.  Mixed  with  egg  albumin  it  does  coagulate 
slightly,  but  more  slowly  than  does  carbolic  acid. 

It  may  be  applied  to  the  gum  to  counteract  a  pulpitis  or  other  localized 
inflammation,  but  it  is  far  inferior  to  iodine  or  carbolic  acid  for  this 
purpose.  It  is  used  chiefly  as  an  antiseptic,  and  it  will,  therefore,  be 
more  fully  discussed  under  that  heading. 

Chloroformum.  Chloroform.  This  drug  is  discussed  fully  in  the 
chapter  on  anesthetics,  but  it  is  mentioned  here  on  account  of  its  irritant 
local  action.  This  action  is  secured  best  when  the  vapor  is  confined. 
The  "thimble  blister"  is  a  convenient  form  of  counterirritation  when 
it  is  to  be  limited  to  a  single  point.  It  is  produced  by  placing  a  bit  of 
cotton  saturated  with  chloroform  in  an  ordinary  thimble  and  applying 
it  closely  to  the  skin  for  five  or  ten  minutes. 

Treatment  of  Blisters.  Bearing  in  mind  that  the  healing  of  injured 
tissues  is  always  a  natural  process,  and  that  any  application  is  to  be 
regarded  onlv  as  an  aid,  the  simpler  we  make  the  treatment  of  blisters 
the  better.  This  involves  the  simple  principles  of  the  treatment  applied 
to  burns,  which  may  be  stated  as  follows: 

1.  Cleanliness. 

2.  Protection  from  air. 

3.  Stimulation  of  repair. 

The  f^rst  is  self-evident  and  requires  only  the  simple  statement  that, 
as  simple  cleansing  applications,  any  but  the  mildest  antiseptics  should 
be  avoided.  Boiled  water,  normal  salt  solution,  and  sterilized  oils  or  fats 
answer  the  purpose  of  cleansing  a  blister  in  most  cases. 

In  the  absence  of  infection  it  is  unnecessary  to  disturb  the  blister  often, 
if  proper  protection  is  employed.  The  natural  process  of  healing  may 
be  disturbed  by  the  daily  removal  of  dressings,  particularly  when  they 
adhere.  Usually  when  we  are  sure  that  the  blistered  surface  is  clean 
and  aseptic  we  can  assume  that  healing  will  progress  without  inter- 
ference. It  is  only  in  case  of  septic  or  unhealthy  conditions  that  fre- 
quent treatment  or  strong  applications  may  be  needed. 

The  second  is  accomplished  by  the  use  of  a  demulcent  such  as  a 
sterile  oil  or  fat,  or  by  any  non-irritating  protective  agent,  and  the  appli- 
cation of  a  dressing  that  will  exclude  the  air.  The  contact  of  air  is 
usually  painful  from  its  drying  effect,  and  it  presents  also  the  danger  of 
infection  of  the  open  sore. 

Carron  oil*  is  a  time-honored  application  to  burns  and  blisters,  but 

*  JAnimentum  calcis,  composed  of  equal  parts  of  linseed  oil  and  lime-water. 


COUNTERIRBITANTS  69 

an  objection  to  its  use  is  the  fact  that  the  drying  of  the  linseed  oil  con- 
tained in  it  makes  the  dressing  hard  and  often  difficult  to  remove  without 
disturbing  the  sore. 

The  third  applies  chiefly  to  large  blisters  that  heal  slowly,  and  includes 
such  measures  as  the  application  of  poultices  of  brewers'  yeast,  which  is 
a  most  excellent  cleansing  and  stimulating  agent.* 

When  healing  is  much  prolonged  and  hindered  by  the  development 
of  excessive  granulations  (proud  flesh),  the  latter  may  be  removed  by 
a  mild  caustic,  such  as  burnt  alum,  or  scraped  away.  Such  removal 
will  often  be  followed  by  more  rapid  healing.  The  last  resort  is  skin- 
grafting,  which  consists  in  transplanting  pieces  of  normal  skin,  from 
some  other  part  of  the  body,  upon  the  denuded  surface,  after  proper 
preparation.  This  will  usually  be  successful  in  securing  a  satisfactory 
epithelial  growth,  with  the  usual  cicatricial  healing  of  the  surface. 

*  The  great  value  of  brewers'  yeast  in  cleansing  and  stimulating  repair  of  indolent 
and  foul  ulcers  is  believed  to  be  due  to  the  nuclein  developed  by  the  yeast  plant. 


CHAPTER  VII. 

ESCHAROTICS. 

Escharotics  or  caustics  are  agents  that  destroy  tissue  upon  contact. 
Many  attack  the  tissue  immediately  and  are,  therefore,  called  corrosives. 

It  will  be  noticed  that  nearly  all  agents  of  this  class  are  strong  chemi- 
cals; that  is  to  say,  they  are  known  and  characterized  by  powerful 
chemical  affinities.  And  this  fact  serves  to  explain  why  they  are  nearly 
all  corrosives.  They  have  so  great  affinity  for  one  or  more  constituents 
of  the  tissues  that  they  destroy  the  organic  structure  in  order  to  satisfy  it. 
It  is  further  noted  that  they  all  differ  somewhat  in  their  effects  upon 
tissue.  This  is  explained  by  their  difference  in  chemical  affinity.*  Thus 
carbolic  acid  has  a  strong  affinity  for  albuminous  matter;  it  cannot  cor- 
rode deeply  because  the  firm  coagulura  immediately  formed  prevents  its 
penetration.  Caustic  potash,  on  the  contrary,  has  no  affinity  for  albumin, 
forms  no  coagulum,  but  penetrates  deeply  into  the  tissue,  displacing 
weaker  bases  from  their  combinations.  It  also  possesses  an  affinity  for 
water.  The  affinities  noted  suggest  the  antidotes  in  case  of  poisoning 
by  each.  The  antidote  to  carbolic  acid  will  be  albumin,  that  to  caustic 
potash  a  dilute  acid,  etc. 

In  the  practical  application  of  caustics  we  prefer  those  that  combine 
efficiency  and  safety,  with  action  self-limited  or  easily  controlled. 

The  strong  acids  and  alkalies  are  prominent,  forming  groups  that 
are  typical  as  to  the  nature  and  action  of  corrosives,  but  they  are  not 
usually  the  agents  of  choice  because  of  the  severity  of  their  effects. 

In  the  grouping  that  follows,  chemical  similarity,  rather  than  simi- 
larity of  action,  is  made  the  basis.  This  facilitates  the  study  of  chemical 
antidotes,  which  apply  as  well  to  groups  as  to  individual  substances. 
Some  agents  that  cannot  be  thus  grouped  are  considered  in  an  unclassi- 
fied list  and  their  chemical  relations  studied  separately. 

*  Experiment.  To  compare  the  coagulant  and  non-coagulant  action  of  caustics : 
Spread  the  white  of  an  egg  upon  a  pane  of  glass  lying  upon  a  dark  surface. 
Place  at  intervals  upon  the  albumen  a  drop  of  each  of  the  mineral  acids,  of 
phenol,  and  of  caustic  soda  or  potash.  Note  that  the  alkali  does  not  coagulate; 
the  acids  and  the  phenol  do,  but  the  coagula  formed  differ  in  firmness. 
(70) 


ESCHAROTICS  71 


Mineral  Acids. 


Acidum  Hydrochloricum.  Hydrochloric  Acid.  (Muriatic  Acid.) 
Contains  31.9  per  cent.,  by  weight,  of  absolute  hydrochloric  acid  [HCl]. 

Acidum  Nitricum.  Nitric  Acid.  (Aqua  Fortis.)  Contains  68  per 
cent.,  by  weight,  of  absolute  nitric  acid  [HNO3]. 

Acidum  Nitrohydrochloricum.  Nitrohydrochloric  Acid.  (Nitro- 
muriatic  Acid,  Aqua  Regia.)  Consists  of  82  parts  of  hydrochloric  acid 
and  18  parts  of  nitric  acid. 

Acidum  Sulphuricum.  Sulphuric  Acid.  (Oil  of  Vitriol.)  Contains  not 
less  than  92.5  per  cent.,  by  weight,  of  absolute  sulphuric  acid  [HgSOJ. 

AppHed  to  living  tissue  mineral  acids  all  coagulate  albumin,  but  nitric 
acid  more  firmly  than  the  others.*  Sulphuric  acid  has  also  a  marked 
affinity  for  water,  and  is  accordingly  the  most  powerfully  corrosive, 
producing  an  effect  very  similar  to  an  ordinary  burn.  They  all  have 
so  great  an  affinity  for  bases  that  they  disorganize  the  tissues  in  order 
to  combine  with  them,  hence  their  extremely  poisonous  effects. 

The  strong  mineral  acids  are  seldom  applied  to  the  mucous  mem- 
brane because  of  the  severity  of  their  action.  Upon  the  skin  they  may 
be  applied  directly  to  warts,  for  the  removal  of  which  a  few  daily  appli- 
cations usually  suffice.  For  this  purpose  nitric  acid  is  preferable, 
because  slightly  less  severe  in  action  than  the  others. 

These  acids  are  caustic  to  bone  as  well  as  to  soft  tissues,  on  account 
of  their  power  to  dissolve  the  earthy  salts  of  bone.  Accordingly,  nitric 
acid  has  sometimes  been  applied  to  small  foci  of  carious  bone  which 
were  not  accessible  for  removal.  Its  action  may  be  checked  at  any  time 
by  the  use  of  a  weak  alkali,  such  as  sodium  bicarbonate  solution  or 
lime-water,  which  should  be  injected  forcibly,  so  as  to  ensure  the  anti- 
dotal reaction  at  the  point  of  the  corrosive  action  of  the  acid,  which 
may  be  at  some  depth.  Employing  in  dental  practice  the  solvent  power 
of  these  acids  upon  mineral  salts,  they  are  sometimes  applied,  slightly 
diluted,  within  a  small  root  canal  to  aid  in  enlarging  the  same.  They 
act  more  rapidly  upon  partly  decomposed  than  upon  sound  dentine. 
In  fact  the  normal  tooth  structure  seems  to  be  little  affected  during  the 
ordinary  time  of  application;  however,  when  the  action  has  proceeded 
as  far  as  is  desired  the  acid  should  be  completely  neutralized.  Sulphuric  ^'^ 
acid  in  50  per  cent,  strength  is  mostly  employed. 

Internally  mineral  acids  are  employed  only  in  diluted  form.     They 
are  further  discussed  under  the  heading  of  Restorative  Tonics. 
*  See  Experiment,  previous  page. 


72 


LOCAL   REMEDIES 


Poisoning  by  Mineral  Acids.  When  a  strong  mineral  acid  is  used 
for  any  purpose,  it  must  be  borne  in  mind  that  it  is  a  dangerous  sub- 
stance, and  great  care  must  be  exercised  to  guard  against  poison- 
ing. The  bottle  should  be  labeled  with  a  poison-label,  such  as 
pharmacists  are  required  to  place  upon  all  powerful  poisons.  The 
dentist  also  should  have  a  ready  knowledge  of  first  treatment  in  cp.se 
of  poisoning;  for  any  treatment,  to  be  of  use,  must  be  employed  very 
promptly,  or  a  fatal  result  may  be  expected.  In  the  presence  of  a  case 
of  poisoning  by  a  strong  mineral  acid,  it  is  not  essential  to  know  just 
which  acid  has  been  swallowed.  The  important  facts  upon  which 
to  proceed  are,  jirst,  that  the  corrosive  action  depends  chiefly  upon 
the  concentration  of  the  acid;  and,  second,  that  the  affinities  of  the 
whole  group  are  so  nearly  identical  that  the  same  antidotal  treat- 
ment will  apply  to  all.  The  first  and  most  important  thing  to  do  is  to 
diluteJhe^^KiisonJreelx^byJargejd^^  This  will  remove 

the  danger  of  further  corrosion,  and,  as  water  is  always  at  hand,  it 
can  be  employed  immediately.  The  use  of  a  chemical  antidote  must  be 
secondary,  because  of  the  time  usually  necessary  for  its  preparation, 
during  which  serious  damage  is  being  done  by  the  corrosive  poison  if 
undiluted.  But  after  free  dilution  the  chemical  antidote  should  be 
given,  so  as  to  completely  neutralize  the  poison.  An  alkali  will  be 
selected,  diluted  if  at  all  irritating,  and  given  freely.  Lime-water  and 
magnesia  are  preferred  to  a  carbonate,  because  the  latter  will,  in  reac- 
tion with  the  acid,  give  off  a  large  quantity  of  carbon  dioxide  gas,  which 
may  cause  painful  distention  of  the  stomach  and  even  endanger  its 
corroded  wall.  In  emergency,  soap,  or  plaster  scraped  from  the  wall, 
may  be  given.  Vomiting  generally  occurs,  and  washing  out  of  the 
stomach  is  facilitated  by  the  early  dilution  with  water  as  recommended 
above.  I..ater  treatment  will  comprise  the  use  of  demulcents,  anodynes 
and  stimulants.  (See  Table  of  Poisons  and  Antidotes.)  The  fact  that 
poisoning  by  strong  mineral  acids  is  usually  fatal,  demands  that 
emphasis  be  placed  upon  immediate  treatment,  as  outlined. 

Organic  Acids. 

Acidum  Aceticum  Glaciale.  Glacial  Acetic  Acid  [HC2H3O2]. 
Nearly  or  quite  absolute  acetic  acid.  It  is  liquid  or  crystalline,  accord- 
ing to  the  external  temperature,  its  melting  point  being  a  little  below 
60°  F.  It  is  colorless,  and  has  a  strong  vinegar-like  odor  and  a  sharp 
acid  taste.     It  is  not  a  coagulant,  but,  on  the  contrary,  is  a  solvent  of 


ESCHAROTICS 


i6 


albuminous  and  fibrous  tissue.  It  is  employed  only  as  a  caustic  and 
to  soften  callous  tissue. 

Acidum  Trichloraceticum.  Trichloracetic  Acid  [CjHClsOJ.  Ob- 
tained by  treating  chloral  hydrate  with  three  times  its  volume  of  fuming 
nitric  acid  and  subsequent  exposure  to  sunlight  and  distillation,  it 
occurs  in  colorless  crystals  that  are  very  deliquescent.  Either  in  crystals 
or  strong  solution  it  is  used  as  a  caustic  to  remove  redundant  tissue, 
as  overhanging  gums,  warts,  etc.  It  coagulates  albumin,  and  may  be 
employed  as  a  test  for  that  substance.  A  20  per  cent,  solution  is  recom- 
mended as  an  application  to  chronic  inflammations  of  mucous  mem- 
branes. In  full  strength  it  may  be  applied  to  the  gum  tissue  to  prevent 
exudation  of  moisture,  the  so-called  "weeping  gums,"  during  filling  or 
setting  of  a  crown. 

In  the  treatment  of  pyorrhea  alveolaris  this  drug  may  be  applied  in 
from  90  per  cent,  down  to  5  per  cent,  strength— the  strongest  solution 
first,  as  a  powerful  escharotic,  and  the  strength  then  gradually  reduced 
to  that  which  is  astringent  and  antiseptic,  having  the  added  advantage 
in  any  strength  of  its  solvent  power  upon  the  calcareous  deposits.  It 
is  also  used  to  obtund-Sensitive  dentine. 

Acidum  Lacticum.  Lactic  Acid.  A  colorless,  syrupy  liquid  com- 
posed of  75  per  cent.,  by  weight,  of  absolute  lactic  acid  [IIC3H5O3]  and 
25  per  cent,  of  water.  It  is  obtained  by  lactic  fermentation  of  milk- 
sugar  or  grape-sugar.  It  is  strongly  acid  in  reaction,  freely  miscible 
with  water,  alcohol,  or  ether;  insoluble  in  chloroform.  It  does  not 
coagulate  albumin,  but  may  be  employed  as  a  solvent  to  fibrinous  exu- 
dates, as  in  diphtheria,  a  20  per  cent,  solution  being  applied.  A  solu- 
tion of  20  to  50  per  cent,  is  used  in  the  treatment  of  pyorrhea  alveolaris 
to  soften  remnants  of  calculary  deposit  in  the  tooth  socket. 

Caustic  Alkalies. 

Aqua  Ammoniae  Fortior.  Stronger  Water  of  Ammonia.  A  28  per 
cent,  solution,  by  weight,  of  ammonia  gas  [NH3]  in  water.  This  solu- 
tion is  not  used  medicinally  to  any  extent,  but  it  is  the  basis  for  the 
preparation  of  spirit  of  ammonia.  It  is  a  volatile  caustic,  the  vapor 
being  extremely  irritating  to  the  air  passages.  The  United  States  Phar- 
macopoeia directs  that  it  should  be  kept  in  strong,  glass-stoppered 
bottles,  not  completely  filled,  in  a  cool  place.  The  bottle  should  be 
opened  cautiously  with  its  mouth  directed  away  from  the  face;  and  if 
the  temperature  is  warm,  the  bottle  had  better  be  cooled  before  opening, 
as  otherwise  the  gas  may  be  under  considerable  pressure.     In  case  of 


74  LOCAL  EEMEDLES 

accidental  swallowing  of  this  caustic,  the  symptom  of  irritation  of  the 
respiratory  tract,  with  dyspnoea,  will  be  prominent.  This  will  call  for  a 
volatile  antidote  in  addition  to  the  free  dilution  of  the  poison  by  water. 
The  proper  antidote  will  be  the  vapor  of  strong  acetic  acid,  in  the 
absence  of  which  strong  vinegar  may  be  swallowed  and  its  vapor  inhaled. 
Stronger  water  of  ammonia  is  a  powerful  saponifying  agent.  It  does 
not  coagulate  albtimin.  The  ordinary  water  of  ammonia  (10  per  cent.) 
may  be  prepared  from  this  stronger  solution  by  diluting  with  twice  its 
volume  of  water. 

Potassii  Hydroxidum.  Caustic  Potash.  Potassa.  Potassium 
Hydrate  [KOH].     So  per  cent,  at  least. 

Sodii  Hydroxidum.  Caustic  Soda.  Soda.  Sodium  Hydrate 
[XaOH].     90  per  cent,  at  least. 

Potassa  and  soda  are  the  only  ones  used  in  dental  practice,  and  these 
very  seldom.  They  are  prepared  in  form  of  sticks,  which  deliquesce 
readily  and  must,  therefore,  be  kept  in  tightly-corked  bottles,  and 
must  not  be  handled  ^^-ithout  protection  of  the  fingers.  Their  affinities 
are  for  water  and  acids.  They  do  not  coagulate  albumin,  therefore 
their  penetration  is  unhindered.  They  corrode  deeply,  causing  severe 
pain.  They  are  in  no  respect  superior  to  iodine  and  carbolic  acid  as 
superficial  caustics,  and  accordingly  have  little  to  recommend  them 
at  the  present  time.  Their  action  is  more  easily  controlled  than  that 
of  arsenic,  as  they  can  be  completely  neutrahzed  by  weak  acids.  They 
may  be  useful  in  the  place  of  arsenic  for  the  removal  of  small  tumors. 

In  poisoning  by  one  of  the  caustic  alkalies  the  usual  rule  of  giving 
water  freely  to  dilute  the  poison  applies,  with  the  additional  advantage 
that  water  satisfies  one  of  the  affinities  of  either  soda  or  potassa.  The 
chemical  antidote  to  follow  dihition  is  any  dilute  acid,  giving  preference 
to  the  less  irritating  vegetable  acids,  such  as^  vinegar  and  lemon  juice. 
(See  Table  of  Poisons  and  Antidotes.)  "\Miile  only  the  strong  alkalies 
are  classed  as  escharotics,  even  the  dilute  solutions  known  as  liquor 
potassii  hydroxidi  and  liquor  sodii  hydroxidi  ( about  6  per  cent.)  are 
decidedlv  caustic  and  irritating  to  mucous  membranes.  As  an  alkali, 
soda  is  slightly  stronger  than  potassa.     Both  are  powerful  saponifiers. 

^  Unclassified  Escharotics. 

Phenol.  Caebolic  Acid  [CrjHoOH].  A  crystalline  product  of  distil- 
lation of  coal-tar.  (For  preparations,  see  Index  of  Drugs.)  The 
internal  dose  is  i  to  2  grains  (gni.  .03-.12i  well  diluted. 

Phenol  Liquefactum.     Liquefied  Phexol.     S6.4  per  cent. 


ESCHAROTICS  75 

[Crude  phenol  is  a  liquid  consisting  of  various  constituents  of  coal- 
tar,  having  an  odor  resembling  that  of  creosote.  It  is  used  only  as  a 
general  disinfectant,  never  internally  as  a  medicine.] 

Phenol  was  discovered  in  1834  by  Runge,  who  gave  it  the  name  of 
carbolic  acid.  In  chemical  nature  this  substance  is  not  an  acid,  but  an 
alcohol,  the  term  "acid"  having  been  given  to  it  probably  on  account 
of  its  corrosive  action.  It  is  only  slightly  acid  to  test-paper,  and  while 
it  combines  with  a  few  bases,  the  resulting  salts  are  so  unstable  as  to 
be  decomposed  by  carbonic  acid.  It  is  not  capable  of  neutralizing 
alkalies.  It  is  a  definite,  crystalline  compound,  with  a  distinct,  sweet- 
ish odor,  soluble  in  about  20  parts  of  water,  very  soluble  in  alcohol, 
glycerin,  ether,  chloroform,  and  oils.  The  crystals  liquefy  easily  in  a 
warm  temperature,  and  reform  when  the  liquid  is  cooled;  but  a  per- 
manent liquid  form  may  be  secured  by  the  addition  of  5  to  10  per  cent, 
of  water  or  glycerin.  By  exposure  the  liquefied  drug  acquires  a  pinkish 
and  later  a  reddish  or  brownish  color,  which  does  not  lessen  its  value. 

According  to  Demant,*  the  color  of  phenol  may  be  removed,  and 
perfectly  white  crystals  again  obtained,  by  adding  11  parts  of  alcohol 
to  89  parts  of  the  phenol,  subjecting  the  mixture  to  freezing,  and  then 
draining  ofl^  the  portion  remaining  liquid. 

In  dentistry  phenol  is  used  more  frequently  than  any  other  drug. 

As  a  caustic  this  drug  differs  from  all  others  in  having  a  local  analgesic 
effect  following  a  momentary  irritation.  Its  most  decided  affinity  is  for 
albumin,  which  it  coagulates  quickly  and  firmly,  thus  limiting  penetration 
beyond  the  superficial  layer  of  tissue. f  Its  analgesic  effect,  combined 
with  a  superficial  but  decided  corrosive  action,  makes  it  an  ideal  caustic 
for  limited  application  to  a  mucous  membrane.  Extensive  application 
might,  indeed,  cause  inflammation  and  symptoms  of  poisoning,  and 
must  be  avoided.  Upon  the  skin  the  action  is  less  energetic,  although 
still  quite  caustic  where  the  skin  is  soft  or  thin.  In  case  of  accidental 
contact  with  tissues,  the  effect  may  be  mitigated  by  the  immediate  ap- 
plication of  alcohol,  as  explained  later  in  the  discussion  of  poisoning. 

The  drug  may  be  applied  pure  to  ulcerated  or  denuded  points,  whether 
painful  or  not,  with  the  results  that  any  septic  process  present  will  be 

*  United  States  Dispensatory,  eighteenth  edition,  p.  37. 

"j"  Experiment.  To  show  the  effect  of  phenol  upon  mucous  membrane  and  tlae 
restorative  effect  of  alcohol:  Evert  the  lower  lip  and,  after  drying,  touch  two  sepa- 
rate points  each  with  the  quantity  of  phenol  that  will  adhere  to  the  head  of  a  pin. 
See  the  white  coagulum  form  at  each  point.  After  half  a  minute  dry  the  surface 
and  apply  a  few  drops  of  alcohol  to  one  coagulum.  Note  the  difference  in  the  two 
points  after  a  few  minutes.     Also  observe  the  results  next  day. 


76  LOCAL  REMEDIES 

antagonized,  and  the  coagulum  formed  will  protect  exposed  nerve  end- 
ings. Thus  applied  to  canker  sores,  it  will  relieve  the  pain  for  a  con- 
siderable time  and  check  the  bacterial  activity.  The  sore  should  first 
be  dried  and  just  sufficient  of  the  pure  drug  applied  to  cover  well 
the  ulcer.  Several  daily  applications  may  be  needed  for  complete 
relief. 

Carbolic  acid  is  not  an  efficient  devitalizing  agent,  because  it  does  not 
penetrate,  and  its  superficial  effect  is  not  sufficiently  irritating  to  induce 
engorgement  of  the  deeper  tissues.  Only  in  deciduous  teeth  is  carbolic 
acid  made  use  of  as  a  pulp  devitalizer.  Here  a  slower  effect  occurs 
from  repeated  applications,  without  the  pain  that  may  attend  the  use 
of  arsenic  and  without  any  danger  of  systemic  disturbance. 

As  a  counterirritant  in  pericementitis  it  may  be  applied  to  the  gum 
in  the  place  of,  or  combined  with,  a  solution  of  iodine.  Also  for  dis- 
infecting alveolar  abscess  and  stimulating  repair,  a  small  quantity  of 
pure  phenol  upon  a  pledget  of  cotton  may  be  introduced  after  the  abscess 
has  been  evacuated;  or,  in  suitable  cases,  it  may  be  pumped  through  the 
apex  of  the  root  into  a  pus  tract  and  through  a  fistulous  opening. 

It  is  frequently  used  as  a  pulp  dressing.  Indeed,  it  is  one  of  the  very 
safest  drugs  to  use  in  proximity  to  the  pulp  or  to  apply  to  an  ex- 
posure, because  of  its  analgesic  action  and  its  superficial  effect.  It  is 
therefore  made  use  of  to  lessen  the  pain  of  an  exposed  or  irritated  pulp 
and  to  obtund  sensitive  dentine.  It  has  been  used  to  lessen  the  sensi- 
tiveness of  the  gums  in  order  to  apply  a  rubber-dam  ligature  far  beyond 
the  gum  margin.  But  for  this,  as  for  nearly  every  purpose  as  an  anal- 
gesic, it  is  inferior  to  cocaine,  and  has  the  further  disadvantage  of 
always  destroying  some  tissue  when  applied  strong. 

The  uses  discussed  thus  far  apply  to  the  pure  carbolic  acid  or  a  slight 
dilution  of  it.  But  the  most  important  place  of  this  substance  in  medi- 
cine is  as  an  antiseptic,  under  which  heading  will  be  discussed  its  more 
general  uses  in  diluted  solutions. 

Poisoning  by  Phenol.  The  poisonous  power  of  this  drug  is  very 
great,  as  the  recently  numerous  deaths  by  suicide  show.  The  symp- 
toms of  poisoning  combine  those  of  local  injury  to  the  lining  of  the 
digestive  tract,  with  shock  and  great  depression  of  the  nervous  system, 
the  latter  often  leading  to  death  within  an  hour.  The  antidotes  are 
albumin  in  the  form  of  raw  egg,  or  milk  or  flour  paste  as  substitutes 
for  it,  and  alcohol.  Albumin  furnishes  material  for  the  poison  to  act 
upon  and  expend  its  corrosive  power  in  coagulation.  It  must  be  given 
early  to  be  of  use.     It  is  a  true  chemical  antidote.     Alcohol  seems  to  act 


ESOHAROTWS  77 

upon  the  corroded  tissue,  lessening  the  destruction  that  would  follow, 
its  action  probably  being  physiological  rather  than  chemical. 

It  has  been  found  that  the  hands  may  be  immersed  in  pure  liquid 
carbolic  acid,  and,  if  washed  immediately  afterward  in  strong  alcohol, 
no  harm  to  the  tissues  will  result.  Also,  if  carbolic  acid  be  applied 
to  the  mucous  membrane  with  the  production  of  the  white,  superficial 
coagulum,  and  strong  alcohol  be  then  applied,  the  white  spot  will 
partly  disappear  and  the  corrosive  action  be  much  diminished.*  An 
explanation  of  this  antidotal  influence  of  alcohol  is  found  in  its  affinity 
for  water,  which  it  draws  toward  the  surface,  thereby  furnishing  more  fluid 
for  redissolving  the  coagulum  and  diluting  any  uncombined  carbolic  acid 
that  may  be  present  in  the  tissue.     (See  Table  of  Poisons  and  Antidotes.) 

The  poisonous  effects  of  phenol  are  not  limited  to  its  local  action 
upon  tissue.t  When  it  is  absorbed  in  considerable  quantity  it  gives  rise 
to  irritating  products  which  may  seriously  damage  the  kidneys,  liver, 
and  other  organs.  Fatty  degeneration  of  various  tissues  has  often 
been  found  post-mortem.  Corresponding  to  this  action  the  urine  in  phenol 
poisoning  often  shows  an  olive-green  or  dark  color.  To  counteract  the 
systemic  poisonous  action  it  is  advised  that  a  soluble  sulphate  be  given  for 
some  time,  so  that  harmless  combinations  may  be  formed  and  eliminated. 

Several  combinations  of  phenol  deserve  mention  because  of  their 
modified  action,  which  is  at  times  desirable: 

Camphorated  phenol,  or  campho-phenique,  consists  of  about  equal 
parts  of  camphor  and  phenol,  which  liquefy  when  heated  together.  It 
is  less  soluble  than  phenol,  and  it  does  not  corrode  tissues.  Used  chiefly 
as  a  disinfectant  canal  dressing  and  as  an  obtundent. 

Liquor  sodii  carbolatis  contains  50  per  cent,  phenol  (see  formula,  p. 
124).  It  is  somewhat  caustic  if  used  in  full  strength.  It  provides  a 
strongly  alkaline  application  for  limited  use  as  a  disinfectant. 

*  See  Experiment,  p.  75  (note). 

f  In  the  Philadelphia  Medical  Times,  vol.  xi.,  p.  284,  Taylor  records  a  case  in 
which  a  man,  who  was  supposed  to  have  swallowed  about  one  ounce  of  carbolic  acid, 
became  comatose  within  three  minutes  and  died  within  four  minutes  from  the  time 
of  taking  the  poison. 

In  the  New  York  Medical  Journal,  November  30,  1889,  Richardson  reports  a 
case  where  equal  parts  of  carbolic  acid  and  sweet  oil,  applied  to  a  burn  on  the  arm 
of  a  child  seven  months  old,  caused  stupor  in  two  hours,  and  death  occurred,  with 
convulsions,  thirty  hours  after  the  application. 

Death  has  followed  the  application  to  the  skin  of  half  an  ounce  of  carbolic  acid  in 
watery  solution,  for  the  purpose  of  destroying  parasites. — Wood's  Therapeutics, 
eleventh  edition,  p.  563. 


78  LOCAL   REMEDIES 

Chloral-phenol,  prepared  by  triturating  together  with  heat,  1  part 
chloral  hydrate  and  3  parts  phenoL  The  product  is  an  oily  liquid  which 
is  used  as  counterirritant  and  local  analgesic. 

Iodized  phenol,  consisting  of  a  mixture  of  iodine  and  phenol  in  vary- 
ing proportions,  whereby  the  irritant  property  is  increased.  Equal 
parts  of  tincture  of  iodine  and  phenol  is  sometimes  used  as  a  counier- 
irritant. 

Argenti  Nitras.     Nitrate  of  Silver  [AgNOg]. 

Argenti  Nitras  Fusus.  ^Moulded  Nitrate  of  Silver.  Lunar  Caustic. 
Moulded  sticks  containing  about  95  per  cent,  of  silver  nitrate. 

Argenti  Nitras  Mitigatus.  Diluted  Nitrate  of  Silver.  Mitigated 
Caustic.  ^Moulded  sticks  consisting  of  1  part  silver  nitrate  and  2  parts 
potassium  nitrate.      (For  solubility  and  doses,  see  Index  of  Drugs.) 

Nitrate  of  silver  occurs  primarily  in  colorless  crystals,  having  a  bitter, 
metallic,  and  somewhat  caustic  taste.  Its  aqueous  solutions  are  neutral. 
From  the  crystals  are  prepared  the  moulded  and  diluted  forms,  which 
are  in  pencils  or  sticks  convenient  for  application.  All  forms  are  freely 
soluble  in  water,  the  pure  salt  being  soluble  in  0.54  part  and  in  24  parts 
of  alcohol. 

This  drug  in  any  form  or  strength  of  solution  turns  dark  upon  ex- 
posure to  sunlight.  This  is  a  standing  objection  to  its  use  about  the 
face,  and  especially  about  a  carious  tooth,  the  structure  of  which  it 
may  stain  permanently  if  allowed  to  penetrate  the  dentinal  tubuli. 

A  stain  upon  the  skin  remains  until  the  stained  epithelium  is  worn 
away.  It  cannot  be  removed  sooner  except  by  paring  or  scraping 
away  the  superficial  layer ;  but  the  stain  upon  a  fabric  may  be  easily 
removed  by  a  weak  solution  of  potassium  cyanide.  The  prolonged 
internal  use  of  silver  in  any  form  may  cause  a  permanent  blueness  of 
the  skin  called  argyria. 

As  a  caustic  its  action  depends  upon  its  affinity  for  albumin,  it  being 
a  decided  coagulant.  Its  application  causes  an  irritation  that  continues 
for  some  time,  but  the  effect  is  quite  superficial  because  of  the  coagulum 
formed,  which  hinders  penetration.  It  has  long  been  used  to  cauterize 
wounds  that  are  probably  infected,  such  as  dog  bites  and  dissection 
wounds,  but  it  must  be  regarded  as  poorly  adapted  to  this  use.  It  does 
not  penetrate  deeply,  therefore  cannot  be  relied  upon  to  destroy  the  in- 
fected tissue,  and  it,  moreover,  by  coagulating  the  surface,  checks  hemor- 
rhage that  might  be  useful  in  washing  away  the  infectious  matter, 
and  it  seals  in,  as  it  were,  the  point  of  infection.  Its  use,  therefore, 
as  a  cauterant  for  deep,  infected  wounds  must  be  condemned. 


ESCHAEOTICS  79 

It  is  one  of  the  most  irritating  caustics  to  the  mucous  membrane,  on 
account  of  the  added  effect  of  a  small  amount  of  nitric  acid  liberated 
by  the  coagulant  reaction. 

The  field  of  usefulness  of  this  drug  is  for  superficial  effect  upon  in- 
visible surfaces,  where  it  is  desired  to  have  the  irritation  pronounced 
or  productive  of  a  secondary  stimulation  of  the  local  circulation.  Ac- 
cording to  the  degree  of  action  desired  it  may  be  applied  in  the  pure 
stick  of  lunar  caustic,  the  stick  of  mitigated  caustic,  or  in  aqueous  solu- 
tion of  1  to  10  per  cent,  strength,  the  weaker  solutions  being  astringent 
rather  than  caustic.  It  is  frequently  applied  to  abort  acute  inflammations 
and  as  a  stimulating  caustic  to  indolent  ulcers. 

In  dental  practice  silver  nitrate  is  used  to  check  caries  in  temporary 
teeth,  where  filling  is  impracticable.  It  was  first  recommended  for 
this  purpose  by  S.  Stebbins,  in  1891.  Szabo,  of  Budapest,  has  made 
the  most  extensive  scientific  study  of  this  action.  He  found  by  experi- 
ments that: 

1.  It  penetrates  one-half  millimeter  (Jg-  of  an  inch)  into  the  dentine. 

2.  The  albumin  unites  with  the  metallic  salt  in  form  of  a  precipitate. 

3.  Granular  albuminate  is  formed  which  the  action  of  light  darkens. 

4.  It  finally  becomes  black  and  insoluble. 

For  the  purpose  stated  it  is  applied  either  in  pure  form,  or  in  saturated 
aqueous  solution,  at  the  point  of  decay.  The  fused  stick  may  be  em- 
ployed, or  some  of  the  crystal  may  be  melted  upon  a  heated  platinum 
point  and  carried  to  the  tooth,  as  recommended  by  Craven;  or  a  silver 
^ire  dipped  in  nitric  acid  may  be  used.  Holmes*  advises,  for  approxi- 
mal  cavities,  to  carry  the  powdered  crystal  adhering  to  a  piece  of  gutta- 
percha, which  has  been  softened  by  heat,  of  proper  size  to  remain  in 
the  cavity.     The  silver  nitrate  is  thus  retained  for  a  long  time. 

Because  of  its  coagulant  power  it  may  also  be  used  to  obtund  sensitive 
dentine  in  cavities  that  are  not  visible,  where  the  staining  would  be 
less  objectionable.  Its  distinctive  antiseptic  value  is  discussed  under 
Antiseptics. 

Incompatibility.  With  albuminous  matter  coagulation  occurs;  with 
hydrocliloric  acid,  soluble  cJilorides,  or  chlorine  solutions,  a  precipitate 
of  chloride  of  silver  occurs;  in  contact  with  most  metals  it  is  reduced 
to  metallic  silver;  an  ac[ueous  solution  acidulated  with  nitric  acid  and 
heated  with  alcohol  will  form  the  explosive  "fulminating  silver." 

In  poisoning  by  silver  nitrate  the  chemical  antidotes  are  albumin  and 
sodium  chloride.  The  latter  forms  with  it  the  insoluble  chloride  of 
*  Pental  Cosmos,  1892,  p.  982. 


80  LOCAL  REMEDIES 

silver.  In  case  of  the  use  of  the  drug  locally  any  excess  may  be  at  once 
removed  by  sodium  chloride  solution.  (See  Table  of  Poisons  and 
Antidotes.) 

Hydrogen  Dioxide  [H2O2],  in  very  strong  ethereal  solution  (25  per 
cent.),  is  a  caustic,  but  its  uses  as  such  have  not  been  very  definitely 
developed  as  yet.  It  is  used  chiefly  as  a  bleaching  agent.  Care  must 
be  taken  in  handling  this  strong  solution  to  avoid  its  action  upon  the 
hands.    Oiling  will  protect  the  skin  from  its  action. 

Alumen  Exsiccatum.  Dried  Alum.  Burnt  Alum  [A1K(S04)2]. 
Alum,  by  being  deprived  of  its  water  of  crystallization,  is  changed  from 
an  astringent  to  a  mild  caustic.  It  has  little  influence  upon  firmly 
organized  tissue.  It  is  used  chiefly  to  destroy  excessive  granulations  in 
wounds  or  ulcers,  the  so-called  "proud  flesh."  The  powder  is  applied 
directly. 

Bromum.  Bromine.  [Br.]  A  heavy  brown  liquid,  which  evolves  a 
brownish,  very  irritating  vapor  at  ordinary  temperature.  It  is  seldom 
used  as  a  caustic,  but  is  very  penetrating,  and  efficient  to  cleanse  foul 
ulcers  or  check  gangrene.  On  account  of  the  irritating  fumes,  it  must 
be  handled  under  water  when  removed  from  the  bottle.  (See  Table 
of  Poisons  and  Antidotes.) 

Cupri  Sulphas.  Sulphate  of  Copper.  Blue  Vitriol  [CuSO^  + 511^3]. 
As  a  mild  caustic  the  pure  crystal  may  be  applied  to  mucous  mem- 
branes, the  typical  condition  for  its  use  being  found  in  granular  eyelids. 
It  is  acid  in  reaction.  In  strong  aqueous  solution  it  has  been  applied  to 
pyorrheal  pockets,  but  here  it  is  an  inferior  agent  because  of  the  danger 
of  discoloring  the  root  and  tooth.  It  is  likewise  astringent,  and  is  more 
fully  considered  in  that  relation.  (See  Table  of  Poisons  and  Anti- 
dotes.) 

Pyrogallol.  Pyrogallic  Acid  [CgH3(OH)3].  Obtained  by  dry  dis- 
tillation of  gallic  acid.  Occurs  in  white  crystals,  becoming  darker 
upon  exposure  to  air  and  light,  very  soluble  in  water  and  in  alcohol. 

This  substance  chemically  is  not  an  acid.  It  has  a  strong  affinity 
for  oxygen,  which  explains  its  caustic  action.  Its  aqueous  solution  at 
first  is  colorless  and  neutral,  but,  by  exposure  to  the  air,  becomes  brown- 
ish in  color  and  acid  in  reaction  from  the  absorption  of  oxygen.  It  will 
stain  the  skin  temporarily  and  fabrics  permanently.  Death  has  occurred 
from  its  absorption  through  the  skin.  It  is  used  chiefly  in  form  of  an 
ointment  in  diseases  of  the  skin. 

Chromii  Trioxidum.  Chromic  Anhydride.  Chromic  Acid  [CrOg]. 
It  occurs  in  purplish-red  crystals,  which  are  soluble  and  deliquescent, 


ESCHAROTICS  81 

forming  chromic  acid.  It  is  an  energetic  caustic,  but  rarely  used.  To 
remove  small  tumors  and  to  lessen  hypertrophy  of  erectile  tissue 
covering  the  turbinated  bones,  it  may  be  applied  cautiously.  It  may 
be  used  to  allay  sensitiveness  of  dentine  in  very  shallow  ca\aties.  It 
should  not  be  mixed  with  other  substances.  With  sugar,  alcohol,  tannic 
acid,  ether,  glycerin  and  other  organic  substances  it  may  decompose 
with  violence. 

Zinci  Chloridum.  Chloride  of  Zinc  [ZnCl2].  (For  zinc  preparations, 
see  Index  of  Drugs.) 

This  substance  occurs  in  white  powder,  or  in  irregular  masses  or 
fused  sticks,  all  of  which  are  intensely  caustic  and  dangerous  to  taste, 
and  acid  in  reaction.  The  salt  is  very  deliquescent,  therefore  the  drug 
may  commonly  be  in  either  solid  or  liquid  form.  It  is  soluble  in  0.3  part 
of  water  and  very  soluble  in  alcohol.  Used  pure  it  is  a  very  energetic 
caustic.  Its  affinities  are  for  water  and  albumin,  therefore  its  action  is 
prompt,  producing  a  firm,  white  eschar.  It  is  held  to  be  the  most 
penetrating  of  all  coagulants.  The  official  liquor  zinci  chloridi  (50  per 
cent.)  may  be  employed,  or  a  stronger  solution  prepared,  as  a  penetrat- 
ing coagulant  agent  within  the  structure  of  the  tooth.  After  removal  of 
the  pulp  it  will  efficiently  disinfect  and  coagulate  the  contents  of  the 
tubuli.  Indeed,  in  the  stronger  solutions,  it  is  used  more  in  treating 
tooth  structure  than  soft  tissues,  on  account  of  the  pain  attending  its 
action  upon  the  latter. 

It  has  long  been  used  in  full  strength  to  lessen  the  sensitiveness  of 
dentine.  Its  action  is  not  a  simple  one,  but  is  based  upon  its  affinity 
for  water  and  its  coagulant  power,  to  which  is  added  the  irritant  influence 
of  a  small  quantity  of  hydrochloric  acid  liberated  in  the  coagulant 
reaction.  Care  must  be  taken  not  to  apply  it  so  near  the  pulp  as  to 
produce  irritation;  and  repeated  applications  may  be  needed  as  exca- 
vation proceeds.  When  irritation  of  the  pulp  is  feared  from  its  use,  the 
cavity  should  be  at  once  irrigated  with  tepid  water.  It  is  one  of  the 
agents  used  to  cauterize  and  stimulate  the  closure  of  alveolar  pockets 
about  the  roots  of  teeth  in  case  of  recession  or  pyorrhea. 

The  following  is  recommended  when  the  aqueous  solution  proves 
very  painful:* 

Gm.  or  c.c. 

R  .—Zinci  chloridi,  2  60        (gr.  xl). 

Alcoholis, 
Chloroformi,  aa      ISl  (f^ss). — M. 

(Hofheinz.) 
*  Dental  Cosmos,  1903,  p.  31. 
6 


82  LOCAL   REMEDIES 

In  the  weaker  solutions  (1  to  20  per  cent.)  it  is  astringent  and  anti- 
septic, and  further  discussion  of  its  uses  will  occur  in  the  chapters  devoted 
to  those  classes  of  agents. 

It  must  be  ranked  as  a  corrosive  poison.  The  preparations  likely 
to  cause  poisoning  are  the  full  strength  liquid,  the  50  per  cent,  solution, 
and  the  popular  "  Burnett's  disinfecting  fluid,"  which  contains  200 
grains  to  the  fluidounce  (about  42  per  cent.).  The  chemical  antidotes 
are  albumin  and  dilute  solution  of  sodium  or  potassium  carbonate.  (See 
Table  of  Poisons  and  Antidotes.) 

Incompatibility.  The  drug  is  incompatible  with  the  antidotes  men- 
tioned above  and  with  nitrate  of  silver. 

Chloride  of  zinc  in  its  liquid  form  enters  into  the  formation  of  the 
oxychloride  of  zinc  filling  cement. 

Arseni  Trioxidum.  White  Arsenic.  Arsenous  Acid  [AsjOg].  (For 
preparations  and  doses,  see  Index  of  Drugs.) 

Following  the  U.  S.  P.  description,  arsenic  is  "a  heavy  solid,  occurring 
either  as  an  opaque  white  powder,  or  in  irregular  masses  of  two  varieties : 
one  amorphous,  transparent  and  colorless,  like  glass;  the  other  crystal- 
line, opaque  and  white,  resembling  porcelain.  Contact  with  moist  air 
gradually  changes  the  glassy  into  the  white,  opaque  variety.  Both  are 
odorless  and  tasteless." 

"In  cold  water  both  varieties  dissolve  very  slowly,  the  glassy  variety 
requiring  about  30,  the  porcelain-like  about  100  parts  of  water  at  25°  C. 
(77°  F.).  Both  are  slowly  but  completely  soluble  in  15  parts  of  boiling 
water.  In  alcohol,  arsenic  trioxide  is  sparingly  soluble,  but  it  is  soluble 
in  about  five  parts  of  glycerin."  An  aqueous  solution  is  only  faintly 
acid  in  reaction. 

Wherever  the  term  "arsenic"  is  used  in  the  following  pages  it  stands 
for  the  official  arsenic  trioxide.  The  characteristic  action  of  the  drug  is 
due  to  the  ion  of  arsenous  acid  and  not  to  the  element  arsenic,  which 
is  insoluble  in  water. 

(The  relations  of  the  drug  as  a  caustic  only  will  be  treated  at  this 
place.    For  its  internal  uses,  see  under  Alteratives.) 

Arsenic  stands  alone  in  its  characteristics  as  an  escharotic.  The  dry 
powder  may  be  placed  on  the  tongue  and  allowed  to  remain  for  one 
minute  without  causing  the  slightest  irritation  and,  if  then  thoroughly 
removed,  without  producing  any  effect  upon  the  tissues.  On  the 
contrary,  if  it  is  allowed  to  remain  until  it  becomes  dissolved  and  pene- 
trates the  tissues,  extensive  sloughing  will  result.  It  cannot  be  called 
an  irritant.    It  is  not  a  corrosive.    It  has  no  decided  chemical  affinities; 


ESCHAROTICS  83 

therefore,  it  is  not  escharotic  by  reason  of  any  apparent  chemical  action. 
It  stands  by  itself  as  a  vital  or  alterative  escharotic,  in  that  it  acts  only 
after  being  absorbed  by  the  tissue  elements,  altering  or  destroying  their 
vital  processes  in  an  obscure  manner.  Because  of  this  action  it  is 
difficult,  if  not  impossible,  to  limit  or  antagonize  its  influence  upon  the 
tissues  which  it  has  penetrated;  and  its  penetration  is  not  limited  by 
any  action  of  its  own.  The  fact  of  its  being  tasteless  and  non-irritating 
at  first,  renders  its  use  about  the  mouth  the  more  dangerous,  for  by 
careless  handling  it  may  become  lodged  about  the  teeth  or  beneath  the 
edges  of  the  gum,  and  its  presence  be  not  appreciated  for  hours,  until 
devitalization  of  the  tissue  has  begun.    It  does  7iot  coagulate  albumin. 

The  drug  acts  slowly,  penetrates  deeply,  and  destroys  tissue  exten- 
sively. It  seems  to  affect  abnormal  or  unorganized  tissue  elements,  as 
in  cancer,  more  readily  than  normal  tissue ;  hence  its  use  in  the  removal 
of  abnormal  growths.  As  an  escharotic  it  is  always  used  in  its  pure 
form,  although  often  mixed  with  other  agents  for  convenience  of  applica- 
tion or  to  mitigate  its  action. 

The  medicinal  solutions  officially  prepared  from  it  are  all  for  internal 
use,  to  secure  the  general  tonic  and  alterative  effects  of  the  drug.  There- 
fore, when  we  speak  of  applying  arsenic  locally  we  mean  always  arsenic 
trioxide  in  powder  form  or  in  mixture.     (See  Index  of  Drugs.) 

Dental  Use.  It  is  rare  that  arsenic  is  used  in  the  mouth  for  any  other 
purpose  than  devitalizing  pulps  of  teeth;  and  it  may  be  said  to-day, 
after  more  than  half  a  century  of  experience  v^th  it  and  with  other  less 
dangerous  but  less  efficient  devitalizants,  that  it  is  the  substance  of  first 
choice  for  this  purpose.  It  is  only  with  deciduous  teeth  that  a  less 
powerful  agent  must  be  chosen.  Here  the  danger  would  be  penetration 
of  the  arsenic  through  and  beyond  the  apex  of  the  root,  with  a  corre- 
sponding extension  of  its  destructive  action. 

With  the  exception  noted,  it  is  true  generally  that  nothing  need  be 
feared,  in  the  way  of  extension  of  its  action,  when  the  drug  is  carefully 
used  upon  the  tooth  pulp.  The  natural  confines  of  the  pulp  cavity  and 
root  canal  prevent  its  penetration  to  other  tissues,  so  that  only  careless 
handling  and  inappropriate  or  excessive  use  need  be  followed  by  bad 
results.  "While  we  must  admit  the  possibility  of  irritation  extending 
beyond  the  pulp  chamber  in  case  of  a  good-sized  apical  foramen,  a 
septic  inflammation  could  not  be  expected  from  the  action  of  the 
arsenic. 

Careful  use  of  the  drug  implies,  first,  isolation  of  the  tooth  to  be 
treated,  by  applying  the  rubber  dam;  second,  the  use  of  a  small  amount 


84  LOCAL  REMEDIES 

of  the  drug;  third,  careful  sealing-in  during  the  period  of  its  action,  and 
fourth,  its  thorough  removal  after  devitalization  is  complete. 

Hofheinz  formulates  the  follov^'ing  rules  for  the  application  of  arsenic 
to  a  pulp: 

1.  Do  not  combine  it  with  an  escharotic. 

2.  Never  use  it  in  deciduous  teeth. 

3.  Do  not  place  it  over  an  aching  pulp. 

4.  Place  it  directly  on  the  pulp. 

5.  Exert  no  pressure  upon  the  pulp. 

6.  Never  crowd  it  into  root  canals. 

7.  Take  special  care  of  the  gum  tissues  if  the  ca^'ity  is  near  the 
gingival  line. 

8.  Let  it  remain  twenty-four  hours  at  least. 

With  the  small  amount  necessary  to  destroy  a  pulp,  systemic  effects 
will  never  occur.  The  ordinary  medicinal  dose  of  arsenic  is  from  -g^g- 
to  -YQ  of  a  grain,  which  need  never  be  exceeded  for  this  use;  according 
to  ^Miller  from  yw  *o  yj  i^  sufficient.  It  should  be  impressed  upon  the 
mind  of  the  practitioner  that  any  untoward  effects,  that  may  follow  his 
emplo^Tuent  of  arsenic  in  a  tooth,  will  be  purely  local  and  the  result 
of  either  want  of  care  in  its  application  or  lack  of  judgment  as  to  its 
appropriateness. 

The  precise  mode  of  action  of  this  drug  as  an  escharotic  cannot  be 
stated  ^"ith  positiveness.  The  several  ^dews  advanced  merit  our  atten- 
tion, but  discussion  of  them  to  a  definite  conclusion  is  hardly  possible. 

Sollmann*  regards  paralysis  of  the  capillaries  as  the  beginning  of  its 
action,  which,  ^xiih  increased  permeability  of  their  walls,  is  followed  by 
exudation  into  the  connective  tissue.  These  changes,  it  is  observed, 
are  very  similar  to  those  of  inflammation.  Fatty  degeneration  of  cells 
results  and  the  destruction  of  tissue  is  accomplished  without  evident 
chemical  reactions.  This  author  finds  support  to  the  theory  of  capillary 
paralysis  in  the  fact  that  intravenous  injections  of  large  quantities  of 
salt  solution  will  cause  edema  in  animals  poisoned  with  arsenic,  but 
not  in  normal.  He  suggests  further  that  the  distention  of  capillaries 
may  lead  to  their  rupture  and  the  formation  of  ecchymoses.  (It  would 
seem  that  such  changes  must  take  place  in  the  walls  of  the  digestive 
tract  in  arsenical  poisoning,  for  the  s^inptoms  and  the  appearance  of 
the  discharges  are  almost  identical  'w'ith  those  of  cholera,  and  the  destruc- 
tion of  tissue  found  after  death  is  regarded  as  due  to  degeneration  and 

*  Sollmann's  Pharmacology,  1901. 


ESCHAROTICS  85 

not  to  any  direct  action  of  the  poison.)  Regarding  changes  in  the  blood 
opinions  differ,  but  Silberman*  asserts  that  arsenic  tends  to  cause  intra- 
vascular coagulation,  and  the  experiments  of  Heinzf  indicate  that  this 
is  not  ordinary  coagulation,  but  formation  of  thrombi  of  blood  plates, 
and  he  attributes  the  hemorrhages  to  such  thrombosis. 

A  theory  of  the  action  of  arsenic  advanced  by  Binz  and  Schultz]};  is 
to  the  effect  that  arsenous  acid  is  oxidized  to  arsenic  acid  by  living  tissue 
and  the  arsenic  acid  is  again  reduced  to  arsenous.  This  alternate  with- 
drawal and  supply  of  oxygen,  in  its  influence  upon  the  protoplasm,  is 
supposed  by  them  to  be  the  essential  feature  of  the  action  of  arsenic. 

Arsenic  will  attack  any  soft  tissue  to  which  it  is  applied,  so  that,  when 
explaining  its  action,  we  must  recognize  its  influence  upon  the  vitality 
of  tissue  apart  from  kind  or  location;  but  within  the  pulp  cavity  and 
upon  so  vascular  and  highly  sensitive  an  organ,  enclosed  as  it  is  by 
bony  walls  with  very  small  unyielding  openings  for  vessels  and  nerves, 
the  factor  of  increased  pressure,  due  to  the  intense  hyperemia,  and 
leading  to  stoppage  of  the  circulation  by  strangulation  of  vessels  or  by 
thrombosis,  is  believed  to  contribute  largely  to  the  destructive  action. 

The  occurrence  of  pain  in  connection  with  pulp  devitalization  depends 
somewhat  upon  the  condition  of  the  pulp.  A  healthy  pulp,  that  has  not 
become  irritated,  may  be  destroyed  without  any  pain ;  but  in  the  average 
case  where  irritation  has  occurred,  it  must  be  expected  that  within  a 
varying  period  of  time  after  the  application,  usually  several  hours,  the 
patient  will  experience  pain,  first  gnawing,  later  throbbing  in  character, 
which  will  continue  until  the  pulp  is  destroyed,  which  is  accomplished 
in  from  six  to  forty-eight  hours,  as  a  rule. 

Combinations.  In  its  use  as  a  devitalizer,  arsenic  is  combined  with 
other  substances  to  meet  two  objects— to  obtain  a  convenient  form  for 
application  and  to  lessen  the  pain  of  its  action.  The  form  mostly 
preferred  is  that  of  a  paste,  which  is  prepared  by  rubbing  up  the  powdered 
arsenic. with  a  sufficient  quantity  of  a  volatile  oil,  creosote,  glycerin  or 
carbolic  acid.  The  antiseptic  character  of  these  drugs  may  be  held  by 
some  to  give  added  value,  but  arsenic  itself  is  a  sufficient  antiseptic  as 
to  really  need  no  addition  on  that  score. §    It  should  be  noted  that  any 

*  Cushny's  Pharmacology,  third  edition,  p.  615. 

t  Ibid.  t  Ibid.,  p.  619. 

I  According  to  Koch's  experiments  (Brunton's  Pharmacology,  1885,  p.  98),  arsenic 
is  one-tenth  as  strong  as  bichloride  of  mercury  in  antiseptic  power.  Cushny  (Phar- 
macology, third  edition,  p.  619)  states  that  it  is  less  poisonous  to  fungi  than  to  higher 
forms  of  life,  and  that  it  seems  to  have  no  effect  upon  the  action  of  pepsin  and  similar 
ferments. 


36  LOCAL  REMEDIES 

strong  coagulant,  such  as  carbolic  acid,  by  coagulating  the  surface  of 
the  pulp  where  the  application  is  made,  will  tend  to  hinder  penetration 
of  the  arsenic,  on  which  account  it  is  inferior  to  a  volatile  oil.  Some- 
times cotton  fibre  is  incorporated  with  the  paste,  and  being  then  dried 
is  known  as  "devitalizing  fibre."* 

To  lessen  the  pain  of  de^^talization  a  number  of  drugs  have  been 
recommended  and  used,  but  the  list  can  now  be  narrowed  down  practi- 
cally to  one,  or  substitutes  for  it.  Cocaine  hydrochloride  possesses  every 
quality  that  is  essential,  with  no  serious  disadvantage.  It  is  soluble,  it 
mixes  with  the  substances  usually  combined  in  the  paste,  and  it  is  more 
efficient  than  any  other  kno^vn  agent.  The  danger  of  absorption  into 
the  general  circulation,  with  the  small  quantity  employed  and  the  barrier 
presented  to  its  penetration,  is  so  slight  that  it  may  usually  be  dis- 
regarded. Any  quantity  not  exceeding  one-quarter  of  a  grain  may  be 
regarded  as  safe  to  use.  Substitutes  for  this  drug  are  eucaine  hydro- 
chloride and  orthoform,  either  of  which  may  be  employed,  but  they 
are  not  more  efficient  than  cocaine.  Their  chief  advantage  is  in  being 
less  toxic,  although  it  may  be  found  by  experience  ^^Ai\l  orthoform  that 
its  influence  is  more  prolonged  because  of  its  insolubility. 

In  considering  this  part  of  the  subject  it  should  be  remembered  that 
pain  in  a  tooth  pulp  can  be  practically  relieved  at  two  points — either 
at  the  pulp,  by  agents  that  paralyze  the  terminals  of  the  sensory  nerve, 
or  at  the  centres  of  appreciation  of  painful  sensation  in  the  brain,  by 
agents  that  depress  or  benumb  those  centres.  Corresponding  in  their 
site  of  action  to  these  two  points,  we  have  two  classes  of  anodynes — ■ 
those  that  act  locally  upon  the  periphery  of  nerves,  and  those  that  act 
centrally  upon  the  centres  for  painful  sensation.  Agents  that  act  locally 
as  anodynes  have  little  or  no  central  effect  in  ordinary  doses,  and, 
conversely,  agents  that  relieve  pain  by  depressing  brain  centres  may 
have  no  effect  of  this  kind  when  applied  locally.  This  line  of  discussion 
is  prompted  by  the  fact  that  morphine  is  so  commonly  recommended  as 

*  One  formula  for  preparing  devitalizing  fibre  contains: 

R . — Arseni  trioxidi,  gr.  v         (Gm.  0.30) 

Acidi  tannic!,  gr.  ij         (Gm.  0.12) 

Morphinse  acetatis,  gr.  x         (Gm.  0.60) 

Acidi  carbolici,  q.  s. 

M.  Make  into  a  thin  paste  and  mix  with  fine  cross-cut  cotton  fibre,  drv  it,  and 
separate  into  small  pieces  for  convenient  application. — Gorgas'  Dental  Medicine, 
fifth  edition,  p.  180. 

This  formula  may  be  variously  modified,  but  especially  in  the  substitution  of 
cocaine  for  morphine,  as  the  latter  has  almost  no  local  action. 


ESCHAROTICS  '  87 

a  local  anodyne  combined  with  arsenic.  This  is  entirely  opposed  to  our 
knowledge  of  the  action  of  morphine.  This  drug  has  almost  no  local 
action  when  applied  to  sensory  nerve  endings,  but  is  anodyne  only 
through  its  central  action,  after  being  absorbed  into  the  blood  in  sufficient 
quantity.  Morphine  locally  applied,  therefore,  can  be  of  little  use  for 
the  purpose  of  mitigating  the  pain  or  irritation  caused  by  arsenic.  This 
fact  was  recognized  many  years  ago*  and  is  fully  supported  by  the  most 
recent  authorities. f  The  volatile  oils,  thymol,  iodoform  and  carbolic 
acid  are  all  feebly  analgesic,  but  inferior  to  cocaine,  while  iodoform  has 
the  disadvantage  of  disagreeable  odor,  and  carbolic  acid  is  a  coagulant. 

Local  Poisoning  by  Arsenic.  The  lodgment  of  arsenic  between  the 
teeth  or  beneath  the  edge  of  the  gum  vidll  cause,  after  some  hours,  local 
irritation  leading  to  engorgement  of  the  gum,  which  will  be  followed 
by  sloughing  if  the  poisoning  is  severe.  Pain  may  be  absent.  These 
symptoms  will  correspond  in  extent  to  the  depth  of  penetration  of  the 
arsenic,  sometimes  including  pericementum  and  alveolus.  All  tissues 
whose  ^dtality  has  been  seriously  disturbed  must  be  expected  to  slough 
away. 

Treatment  of  this  condition  will  include  the  removal,  by  cutting 
or  scraping,  of  all  tissue  that  has  been  destroyed,  the  scarification  of 
engorged  tissue  and  washing  away  of  any  particles  of  the  drug  that  may 
remain  undissolved,  by  injecting  a  stream  of  water  between  tooth  and 
gum,  which  should  be  separated  for  the  purpose.  As  a  rule,  when  the 
patient  presents  with  these  symptoms  the  damage  will  have  been  done, 
and  local  medication  is  of  doubtful  value.  But  if  any  arsenic  still 
remains  about  the  tissues,  the  freshly  prepared  ferric  hydrate|  will 
neutralize  it  wherever  accessible.  The  latter  may  be  packed  about 
the  teeth  and  beneath  the  gum  margin;  or  it  has  been  suggested  that 
if  the  cavity  be  near  the  gum  the  latter  may  be  treated  freely  with  the 

*  Harris'  Principles  and  Practice  of  Dentistry,  tenth  edition,  1876,  page  371. 
"Morphine  was  formerly  supposed  to  modify  the  irritating  action  of  arsenous  acid, 
but  since  this  has  been  discovered  not  to  be  the  case,  its  use  has  been  dispensed  with 
by  many." 

t  Cushny,  Pharmacology  and  Therapeutics,  1901,  page  208.  "It  is  often  stated 
that  the  sensory  terminations  are  paralyzed  by  morphine,  and  solutions  are  therefore 
injected  into  the  seat  of  pain,  or  liniments  are  rubbed  into  the  skin  over  it,  but  as  a 
matter  of  fact,  morphine  seems  entirely  devoid  of  any  such  local  action." 

Sollmann,  Pharmacology,  1901,  page  204.  "Particular  stress  must  be  laid  on  the 
fact  that  the  sensory  endings  are  in  no  way  affected,  so  that  the  local  application  of 
morphine  or  opium  is  entirely  irrational." 

X  See  Table  of  Poisons  and  Antidotes. 


88  LOCAL  REMEDIES 

antidote  before  using  the  arsenic.  Dialyzed  iron  has  been  recommended, 
but  it  is  inferior  to  fresh  ferric  hydrate.  Tincture  of  iodine  is  beUeved 
by  some  to  be  a  useful  apphcation,  and  the  same  may  be  said  of  tincture 
of  chloride  of  iron,  but  neither  of  these  exert  any  antidotal  action  except 
as  they  stimulate  the  tissues  to  better  resistance.  Scarification  will 
usually  precede  the  use  of  any  of  these  agents. 

General  Poisoning  by  Arsenic*  Acute  general  poisoning  occurs  as  the 
result  of  an  overdose  being  taken  into  the  stomach.  Usually  the  symp- 
toms develop  slowly,  beginning  mth  gastrointestinal  irritation.  There 
is  in  most  cases  sufficient  time  to  administer  an  antidote  and  empty 
the  stomach  if  the  mistake  of  dosage  is  discovered  at  once.  An  ordinary 
emetic  is  to  be  given  at  once  (one  to  three  teaspoonfuls  of  mustard  flour 
in  a  glass  of  lukewarm  or  cold  water,  or  the  same  quantity  of  either 
powdered  alum  or  common  salt  with  a  little  water,  or  one-third  of  a 
teaspoonful  of  sulphate  of  zinc);  meantime  the  antidote  should  be  pre- 
pared and  given.     (See  Table  of  Poisons  and  iVntidotes.) 

Cobalt  (not  official).  "\'Miile  pure  cobalt  [Co]  is  a  distinct  chemical 
element,  in  the  commercial  form  arsenic  is  associated  with  it.  It  is 
employed  to  devitalize  pulps,  and  in  this  use  it  acts  very  much  like 
diluted  arsenic,  being  slower  in  action  and  less  irritating  than  pure 
arsenic,  and,  in  some  cases,  even  painless. 

Atoxyl.  Arsenic-acid  Anilide  (not  official).  This  new  compound 
contains  37.7  per  cent,  of  arsenic.  It  has  been  employed,  with  reported 
success,  as  a  substitute  for  arsenic  in  the  devitalization  of  pulps.  The 
advantage  claimed  is  that  it  presents  less  danger  of  poisoning.  It  is 
true  that  it  may  be  taken  internally  in  much  larger  dose  than  arsenic 
(the  dose  being  i  to  3  grains).  It  is  too  recent  a  compound  to  permit 
of  final  conclusions  as  to  its  value. 

Actual  Cautery.  This  term  applies  to  the  use  of  heat  of  sufficient 
degree  to  burn  the  tissue.  Formerly  an  iron  or  silver  wire  was  employed, 
heated  to  a  white  heat.  Pulps  were  destroyed  by  plunging  the  heated 
wire  directly  into  the  pulp  canal.  Fortunately  both  the  means  and  its 
use  have  become  obsolete.  Nevertheless  heated  metallic  points  and 
wire  loops  are  frequently  employed  in  general  and  special  surgery  to-day. 
The  approved  methods  of  applying  the  actual  cautery  are  the  following: 

*  The  fact  may  be  stated  that  in  some  parts  of  the  world,  especially  in  Styria,  the 
peasants  take  arsenic  habitually  and  acquire  a  tolerance  to  the  drug,  so  that  they 
take  quantities  which  would  ordinarily  be  poisonous.  It  is  claimed  that  it  secures 
a  ruddy  complexion  and  plumpness  of  form,  as  its  action  favors  the  deposit  of  fat 
in  the  tissues,  and  that  mountain-climbing  is  easier  under  its  use,  requiring  less  effort 
and  producing  less  respiratory  discomfort. 


ESCHAROTICS  89 

Thermocautery,  Under  this  term  there  is  arranged  an  apparatus,  by 
means  of  which  a  platinum  point,  pre\ioiisly  heated  up  in  a  gas  or  spirit 
flame,  is  maintained  continuously  at  a  white  or  red  heat  by  the  com- 
bustion of  gasoline  vapor  forced  through  it.  Paquelin's  thermocautery 
is  the  one  mostly  used.  Platinum  points  of  various  sizes  and  shapes 
permit  an  extensive  use  of  this  method  for  removal  of  small  tumors, 
checking  hemorrhage,  etc.  It  is  seldom  used  about  the  mouth,  preference 
being  given  to  the  galvanocautery. 

Galvanocautery.  This  consists  of  a  galvanic  battery,  arranged  in 
simple  circuit — i.  e.,  with  all  positive  elements  connected  together  and 
likewise  all  negative,  so  as  to  equal  in  effect  one  large  cell.  A  battery 
so  arranged  presents  a  large  surface  of  elements  ^dth  the  resistance  of 
only  one  cell.  It  furnishes  a  large  quantity  of  electricity  capable  of 
producing  a  high  degree  of  heat  when  it  meets  mth  external  resistance. 
Platinum  loops  in  various  shapes  and  sizes,  adapted  to  cutting,  searing 
or  snaring  tissue,  are  employed.  One  of  these  mounted  upon  a  suitable 
hand-piece  and  included  in  the  current  furnishes  a  sufficient  resistance 
to  convert  the  electricity  into  heat,  the  degree  of  which  can  be  easily 
regulated  by  manipulation  of  the  battery. 

A  great  advantage  attaching  to  this  method,  for  use  about  the  face 
and  mouth,  is  that  the  patient  need  not  see  the  heated  loop.  It  may  be 
placed  right  in  proximity  to  the  diseased  or  bleeding  tissue  before  the 
current  is  turned  on;  and  if  the  application  of  cocaine  precedes  its  use 
the  pain  is  not  severe. 


CHAPTEE  VIII. 

._/      DEMULCENTS  AND  EMOLLIENTS. 

DEMULCENTS. 

DE:\ruLCEXTS  are  agents  that  protect  or  soothe  raw,  irritated  oi 
inflamed  surfaces.  They  consist  chiefly  of  oily,  mucilaginous  or  albumi- 
nous substances,  of  v^-hich  the  ones  here  named  are  the  most  important: 

Oleum  Oliva?  (olive  oil).  Acacia  (gum  arable). 

Oleum  Lini  (linseed  oil).  Linum  (flaxseed). 

Oleum  Goss^-piiSeminis  (cottonseed  oil).  Ulmus  (slippery  elm  bark). 

Petrolatum  liquidum  (^albolene).  Albumin. 

The  oils  are  used  in  their  ordinary  form,  as  a  rule;  sometimes,  how- 
ever, the  addition  of  an  alkali  is  ad\isable,  and  such  combination  is 
found  in  the  time-honored  "carron  oil,"  kno-^m  ofiicially  as  linimentum 
calcis.*  This  has  long  been  a  favorite  application  to  burns  and  scalds. 
A  disadvantage  in  its  use  lies  in  the  fact  that  linseed  oil  dries  upon 
exposure,  and  the  stiffening  of  the  dressing  which  results  may  make  it 
more  difficult  to  remove.  This  may  be  ob\dated  by  substituting  cotton- 
seed oil  for  linseed  oil  in  the  combination. 

In  poisoning  by  corrosives  and  irritants,  demulcents  are  valuable  to 
protect  the  injured  surfaces.  Any  of  the  above  are  applicable,  except 
that  in  poisoning  by  phosphorus  or  cantharides  oils  should  not  be  used, 
as  they  are  solvents  for  these  drugs.  In  any  case  where  albtimin  is  the 
proper  antidote  it  may  be  the  demulcent  of  choice  so  as  to  serve  a  double 
purpose. 

The  mucilaginous  drugs  are  employed  in  aqueous  solution,  either 
infusion,  mucilao-e  or  svrup,  and  are  for  internal  use,  being  seldom 
applied  externally  except  in  poultices,  ^"\^len  flaxseed  tea  is  to  be 
prepared,  the  whole  seed,  not  ground,  should  be  treated  with  hot  water. 
The  mucilage  is  present  in  the  shell  and  is  thus  easily  dissolved  out. 
The  ground  seed  is  used  only  in  poultices. 

Certain  sialagogues  and  expectorants  may  exert  a  secondary  demulcent 
effect  through  stimulating  secretion  in  the  irritated  or  inflamed  part. 

Gm.  or  c.c. 

*  R .— Olei  lini,  60  (fg  ij) 

Liquoris  calcis,  60  (f^  ij) — M. 

Sig. — Apply  freely  and  cover  with  dressing. 
(90) 


DEMULCENTS  AND  EMOLLIENTS  91 

Irritation  of  the  air  passages,  and  particularly  an  irritative  cough,  is 
often  due  to  dryness  of  the  mucous  membrane.  Sialagogues  or  expec- 
torants may  be  the  very  best  agents  to  relieve  this  irritation  by  increasing 
secretion,  which  moistens  the  irritated  surface,  and  at  the  same  time 
the  engorgement  of  the  tissue  is  lessened.  The  drugs  mostly  used  in 
this  way  are: 

Cubeba  (cubeb  berries).  Ipecacuanha. 

Glycyrrhiza  (licorice  root).  Ammonii  chloridum. 

EMOLLIENTS. 

Emollients  are  agents  that  soften  and  soothe  an  inflamed  part.  Fatty 
preparations,  in  the  form  of  ointments,  are  used  to  soften  the  skin  and 
at  the  same  time  protect  denuded  or  ulcerated  surfaces  from  dust  and 
from  the  drying  effect  of  the  air.  Among  the  fats,  lanolin  (adeps  lanse), 
the  fat  of  sheep's  wool,  deserves  special  mention  as  a  valuable  emollient. 
Its  penetrating  and  softening  power,  it  is  claimed,  exceeds  that  possessed 
by  any  other  fat ;  and  it  has  the  unique  property  of  mixing  with  at  least 
30  per  cent,  of  its  own  weight  of  water  without  losing  its  ointment-like 
character.  The  latter  quality  permits  the  use  of  solutions  of  salts  or 
alkaloids  in  an  ointment,  which  is  often  desirable,  as  in  case  of  a  pain- 
ful sore.  Here  a  crystalline  substance  like  cocaine  should  be  more 
active  when  in  solution  and  mixed  with  lanolin,  than  when  the  particles 
are  simply  rubbed  up  with  a  fat  that  has  feeble  penetrating  power. 

Where  protection  by  a  fat  is  the  chief  purpose,  lard  (adeps)  and 
vaseline  (petrolatum)  are  the  most  commonly  employed  bases  for  oint- 
ments, but  in  softening  and  penetrating  power  they  seem  to  be  inferior 
to  lanolin.  Lard,  being  an  animal  fat,  is  better  in  this  respect  than 
vaseline,  which  is  not  a  true  fat,  but  a  product  obtained  in  the  distillation 
of  petroleum. 

The  poultice  (cataplasm)  is  another  form  of  emollient  application. 
Various  substances  may  enter  into  the  composition  of  poultices,  but  the 
possibilities  of  their  use  are  most  typically  combined  in  ground  flaxseed. 
The  shell  of  this  seed  contains  15  per  cent,  of  mucilage  and  the  interior 
contains  25  to  40  per  cent,  of  oil.  By  treating  the  ground  seeds  with  hot 
water  we  obtain  a  poultice  having  the  emollient  qualities  of  both  oil  and 
mucilage.  Applied  hot  the  relaxing  effect  of  the  heat  contributes  to  the 
softening  process,  and  altogether  we  have  in  the  poultice  a  great  aid 
in  either  resolving  an  inflammation,  or  hastening  suppuration  when  it 
cannot  be  prevented. 


92  LOCAL  REMEDIES 

Glycerinum.  Glycerin.  This  substance  is  obtained  by  decomposi- 
tion of  oils  and  fats,  being  a  by-product  in  the  manufacture  of  soaps, 
and  it  should  contain  not  less  than  95  per  cent,  of  absolute  glycerin 
[C3H,(OH)3]. 

It  is  a  thick,  heavy,  colorless  liquid,  neutral,  freely  soluble  in  water, 
in  alcohol  and  in  a  mixture  of  1  part  ether  and  3  parts  alcohol,  but 
insoluble  in  ether,  chloroform  and  oils.  It  has  a  sweet  taste,  and  when 
applied  to  a  mucous  surface  produces  a  warm  or  burning  sensation. 
It  does  not  coagulate  albumin.  The  chief  quality  that  determines  its 
action  upon  tissue  is  its  marked  affinity  for  water,  it  being  capable  of 
absorbing  50  per  cent,  of  its  own  weight;  therefore,  when  applied  to  a 
raw  surface  glycerin  may  irritate  by  its  energetic  abstraction  of  water, 
but  it  does  not  irritate  the  unbroken  skin  or  mucous  membrane.  Its 
effect  upon  tissue  is  to  soften  and  protect. 

As  an  emollient,  glycerin  is  used  extensively  in  hand  lotions  and, 
either  in  full  strength  or  diluted  with  an  equal  quantity  of  water,  as  a 
simple  application  to  chapped  hands.  Here  its  action  is  typically  seen. 
The  smarting  at  first  experienced  is  due  to  its  abstraction  of  water  from 
the  tissues  wherever  the  skin  is  cracked  or  broken.  This  is  succeeded 
by  a  softness  of  the  skin,  due  to  the  increased  amount  of  moisture 
which  is  attracted  into  the  superficial  layers  of  epithelium  by  the  action 
of  the  glycerin.  When  we  observe  that  chapping  of  the  hands  occurs 
mostly  in  cold  weather,  when  the  absolute  moisture  of  the  atmosphere 
is  greatly  reduced  by  precipitation,  we  can  appreciate  the  importance, 
as  a  causative  factor,  of  excessive  drying  of  the  skin  by  the  surrounding 
air;  and  we  are  helped  to  an  understanding  of  the  value  of  glycerin  as 
a  retainer  of  moisture  wherever  applied  to  soft  tissues.  The  maintenance 
of  a  normal  degree  of  moisture  is,  of  course,  essential  to  the  healing  of 
wounds  of  the  skin. 

Roughness  of  the  hands,  or  of  the  skin  of  other  parts,  is  effectually 
treated  by  a  lotion  of  glycerin  and  water,  or  glycerin,  water  and  alcohol. 
If  there  is  a  tendency  to  scaling  of  the  epithelium,  or  increase  of  seba- 
ceous secretion,  as  in  "dandruff"  of  the  scalp,  the  addition  of  salicylic 
acid  is  very  useful.     The  following  formula  is  suggested: 


Sig.- 


-Acidi  salicylici, 
Alcoholis, 

Gm 

or  c.c. 
1 

30 

(gr.  xv) 
(fSJ) 

Glycerini, 
Olei  amygdate 
Aquse, 
—Hand  lotion! 

arnarse, 

q.  s. 

30 
ad  90 

(fSj) 
30     (n^v) 
ad(f5iij).— M 

DEMULCENTS  AND  EMOLLIENTS  93 

Glycerin  keeps  indefinitely  and  is  even  classed  among  the  antiseptics. 
It  is  an  excellent  preservative.  It  is  used  also  as  a  solvent  and  vehicle 
for  other  drugs,  and  is  often  incorporated  in  small  amount  with  extracts 
in  order  to  keep  them  from  becoming  dry. 

Its  combination  v^ith  tannic  acid,  known  as  glycerite  of  tannic  acid,* 
is  a  powerful  astringent.  In  dentistry  it  is  used  in  case  of  hyperemia 
of  the  pulp  previous  to  capping;  also  after  the  application  of  arsenic  to 
a  pulp,  it  may  be  employed  to  harden  or  tan  the  pulp  tissue  in  order 
to  facilitate  its  removal.  It  is  a  generally  useful  astringent  to  mucous 
membranes. 

Incom'patihility .  With  horax  a  solution  is  formed  which  becomes 
acid  in  reaction,  but  whose  value  is  not  otherwise  lessened.  Glycerin 
should  never  be  combined  with  nitric  and  sulphuric  acids,  nor  with 
chromic  acid,  chlorinated  lime  or  potassium  permanganate,  for  fear  of 
explosive  results. 

*  The  official  Glyceritum  Acidi  Tannici  has  the  following  formula: 

Gm.  or  c.c. 

R . — Acidi  tannici,  201 

Glycerini,  80| 

M.     Heat  mixture  until  complete  solution  occurs. 


CHAPTER  IX. 

ASTRINGENTS  AND  HEMOSTATICS. 

Astringents  are  agents  that  cause  contraction  of  tissue.  In  a 
general  view  of  the  use  of  astringents,  we  may  include  the  checking  of 
hemorrhage  and  of  diarrhea  by  local  medication.  The  terms  hemostatic 
and  styptic  apply  to  agents  that  arrest  hemorrhage.  Most  of  these  act 
by  securing  coagulation  of  the  blood,  but  some  act  mechanically,  such 
as  ligatures  and  bandages,  and  others  lessen  the  blood  supply  to  the 
bleeding  part,  as  cold  and  arterial  sedatives.  Other  styptics,  comprising 
a  number  of  agents,  induce  contraction  of  the  arterioles;  ergot,  antipyrin, 
adrenalin  and  the  local  apphcation  of  hot  water,  all  act  in  this  way, 
ergot  acting  only  through  the  central  nervous  system.  Collodion  exerts 
pressure  through  contraction  of  its  volume  while  drying.  It  must  be 
borne  in  mind  that  the  one  object  of  employing  any  hemostatic  is  to 
secure  coagulation  of  blood  at  the  point  of  hemorrhage;  and  the  employ- 
ment of  the  various  agents  can  only  facilitate  this  process,  so  that  the 
use  of  coagulating  agents,  the  lessening  of  the  amount  of  blood  in  the 
part,  the  contraction  of  arterioles,  and  the  employment  of  pressure,  all 
have  precisely  the  same  object,  but  secure  it  in  different  ways.  The 
choice  of  agent  depends  upon  locality  and  size  of  the  vessels  that  are 
injured. 

A  capillary  hemorrhage  can  usually  be  controlled  by  coagulants,  or 
cold,  or  agents  like  antipyrin  or  adrenalin,  which  cause  the  arterioles  to 
contract.  If  the  hemorrhage  is  from  a  larger  vessel,  or  from  a  tooth 
socket  where  the  muscular  control  of  the  capillary  circulation  is  deficient, 
pressure  upon  the  bleeding  points,  or,  in  extreme  cases,  ligation  of  the 
vessel,  may  be  required.  Again,  in  case  of  hemorrhage  from  the  bowel 
or  lung,  perfect  rest  of  body  and  mind,  the  ice-water  coil  and  arterial 
sedatives  will  be  employed.  But  with  all  our  art  we  are  only  aiding 
nature  to  secure  coagulation. 

The  following   classification  will    aid   our    consideration   of    these 
agents : 
(94) 


ASTRIXGEXTS   AXD    HEMOSTATICS  95 

Classificatiox  of  Hemostatics. 

Coagulant  Astrixgexts. 

1.  Vegetable. 

Tannic  acid. 

Drugs  containing  tannic  acid; 

Nutgall.  Hematoxylon. 

Gambir  (catechu').      Hamamelis. 

Kino.  Tea. 

Krameria.  Cotree. 

Alcohol. 

2.  Mineral. 

Iron  preparations: 

Tincture  of  ferric  chloride. 

Solution  of  ferric  chloride. 

Ferrous  sulphate. 

Ferric  subsulphas  (ZMonsel's  salt). 

Solution  of  ferric  subsulphate. 
Alum. 

Copper  sulphate. 
Lead  acetate. 
SUver  nitrate.* 
Zinc  chloride.* 
Zinc  sulphate. 
Vascular  Astringents. 

1.  Those  that  act  locally: 

Antipyrin. 

Adrenalin. 

Cocaine  hydrochloride. 

Hydrogen  dioxide  (3  per  cent."). 

Heat. 

2.  Those  that  act  aper  absorption  into  the  general  circulations 

Ergot. 
Galhc  acid. 
Remedies  tblvt  Favor  Coagulation  of  the  Blood. 

1.  By  reducing  blood  pressure: 

Cold. 

Arterial  sedatives: 

Aconite. 

Yeratrum  \"iride. 

2.  By  acting  on  the  blood  to  increase  its  coagulant  property: 

Calcium  chloride. 
Thyroid  preparations. 

3.  By  causing  direct  pressure  or  occlusion  of  i^essels: 

Collodion.  \ 

Bandages,  ligatures,  and  other  surgical  measures. 

*  Caustic  in  full  sTrensjth. 


96  LOCAL   REMEDIES 

Application  of  Cold.  By  this  is  meant  not  only  the  abstraction  of  heat, 
which  may  be  desirable,  but  also  the  contact  of  a  substance  having  a 
low  temperature  with  the  skin,  in  order  to  cause  a  reflex  contraction  of 
the  muscularis  of  the  skin  and  of  the  arterioles. 

The  ice-bag,  ice-water  or  ice  directly  applied  are  the  usual  means. 
If  considerable  surface  is  to  be  treated,  a  very  convenient  method  of 
applying  ice-water  continuously  is  by  means  of  the  Leiter  coil,  which 
consists  of  soft-rubber  tubing  coiled  concentrically  to  fit  upon  the  part 
(as  in  form  of  skullcap  for  the  head),  or  wound  about  an  affected  joint; 
through  the  tubing  ice-water  is  run  by  siphonage  as  constantly  as  may 
be  desired.  Cold  applications  will  be  found  useful  to  lessen  the  hyper- 
emia of  acute  inflammation  and  to  lessen  the  amount  of  blood  in  the 
locality  of  a  hemorrhage.  The  twofold  action  induced  is  reduction  of 
blood  supply  and  condensation  of  tissue.  In  employing  cold  locally  to 
relieve  toothache  we  secure  its  astringent  action  upon  the  local  circu- 
lation, and  we  also  have  the  sedative  effect  of  the  cold  upon  the  nerve 
endings.  A  pulpitis  may  sometimes  be  reheved  by  the  contact  of  ice 
with  the  tooth  and  contiguous  tissues. 

Application  of  Heat.  Practically  the  only  uses  of  heat  as  a  hemostatic 
are  two — first,  as  hot  water  applied  to  a  surface  where  there  is  oozing 
from  small  vessels,  the  heat  causing  vascular  constriction  through 
irritation,  and,  second,  as  some  form  of  actual  cautery,  by  which  the 
bleeding  point  is  seared. 

Coagulant  Astringents  (Vegetable). 

Tannic  acid  is  the  astringent  principle  in  each  drug  of  the  vegetable 
group,  therefore  a  discussion  of  its  action  and  uses  will  suffice  for  all. 

Acidum  Tannicum.  Tannic  Aero.  Tamim  [HCi^HgOJ.  Anorganic 
acid  obtained  usually  from  nutgall.  It  is  a  yellowish  powder,  becom- 
ing darker  upon  exposure;  soluble  in  less  than  1  part  of  either  water 
or  alcohol,  and  in  about  1  part  glycerin  with  the  aid  of  moderate 
heat. 

Its  chief  action  is  that  of  a  coagulant.  It  has  a  bitterish  and  astringent 
taste,  but  is  non-irritating  to  the  tissues.  It  is  acid  in  reaction.  It  must 
be  applied  locally,  as  it  has  no  effect  through  the  circulation;  in  fact, 
tannic  acid  is  never  absorbed  into  the  circulation.  When  taken  into  the 
stomach  it  unites  with  any  albuminous  matter  present,  it  interferes  with 
the  activity  of  pepsin,  and,  if  in  excess,  some  may  be  converted  into 
gallic  acid,  which  can  be  taken  up  into  the  system.    The  drug  may  be 


ASTRINGENTS  AND  HEMOSTATICS  97 

applied  in  powder  to  a  bleeding  point,  or  packed  with  cotton  into  a 
tooth  socket.  In  any  strength  of  solution  it  may  be  applied  to  inflamed, 
raw  or  ulcerated  mucous  surfaces,  or  used  as  a  gargle. 

In  catarrhal  and  relaxed  states  of  the  mucous  membrane  it  is  a  useful 
application,  especially  when  combined  with  glycerin.  Being  incom- 
patible with  alkaloids,  it  is  used  as  a  chemical  antidote  to  them.  In 
hemorrhage  from  the  stomach  it  is  taken  in  strong  solution  or  powder 
form,  but  for  internal  hemorrhages  outside  of  the  digestive  tract  it  is 
of  no  value,  except  as  it  is  changed  into  gallic  acid,  which  may  be 
absorbed  and  exert  some  general  influence. 

Tannic  Acid  Group  or  Vegetable  Astringents.  All  vegetable  astringents 
owe  their  activity  to  the  tannic  acid  which  they  contain,  so  it  is  a  matter 
of  personal  choice  whether  the  pure  acid  or  a  drug  containing  it  be 
used.  For  hemostatic  purposes  preparations  of  astringent  drugs  are 
rather  weak,  but  for  a  mouth  wash  or  gargle  they  are  useful.  (For 
preparations  and  doses,  see  Index  of  Drugs.) 

Incompatibility.  Tannic  acid  drugs  are  incompatible  with  albumin,  al- 
kaloids, ferric  salts,  lime-water,  mineral  acids  and  most  metallic  salts. 

Galla.  NuTGALL.  An  excrescence  occurring  on  certain  species  of 
oak,  caused  by  the  puncture  and  deposit  of  ova  of  an  insect.  This  is 
the  source  of  the  official  tannic  acid.  The  tincture  and  the  ointment 
are  the  chief  preparations  of  nutgall. 

G-ambir.  Catechu.  An  extract  prepared  from  leaves  and  twigs  of 
Ourouparia  gambir.     The  compound  tincture  and  troches  are  used. 

Kino.  The  inspissated  juice  of  Pterocarpus  marsupium.  The  tincture 
is  the  only  official  preparation. 

Krameria,  Rhatany.  The  root  of  several  species  of  Krameria. 
This  drug  has  a  number  of  preparations.     (See  Index  of  Drugs.) 

Hematoxylon.  Logwood.  The  heart-wood  of  Hoematoxylon  cam- 
pechianum.  Besides  tannin,  this  drug  contains  heematoxylin,  which 
is  used  to  stain  microscopic  specimens.     The  extract  is  official. 

Hamamelis.  Witch-hazel.  The  leaves  and  bark  of  Hamamelis 
virginiana  collected  in  autumn.     The  fluidextract  is  official. 

Tea  and  Coffee.  Although  not  official,  tea  leaves  and  coffee  seeds 
contain  a  large  amount  of  tannic  acid. 

While  all  tannins  are  similar,  some  may  be  distinguished  by  their 
reaction  with  ferric  salts,  e.  g.,  gallotannic  acid  will  yield  a  bluish-black 
and  kinotannic  acid  a  greenish-black  ink. 

Drugs  of  this  group  are  non-poisonous.  Their  preparations  may  be 
used  freely  as  astringents  either  in  full  strength  or  diluted  with  water. 

7 


98  LOCAL  REMEDIES 

Alcohol.  Rectified  Spirit.  Ethylic  Alcohol  [C2H5OH].  A  liquid 
composed  of  about  95  per  cent,  by  volume  (92.3  per  cent,  by  weight)  of 
ethyl  alcohol  and  about  5  per  cent,  by  volume  (7.7  per  cent,  by  weight) 
of  water.  Sp.  gr.  about  0.816  at  60°  F.  It  is  obtained  by  fermentation 
of  grain  or  the  juices  of  fruits,  and  subsequent  distillation.  It  is  a 
clear,  colorless,  volatile  liquid,  with  a  burning  taste  and  a  distinctive 
odor.     Alcohol  boils  at  172.4°  F. 

This  agent  is  neutral.  It  has  a  great  affinity  for  water,  even  absorb- 
ing it  from  the  atmosphere,  and  it  coagulates  albumin.  It  is  inflam- 
mable, burning  with  a  blue  flame  which  is  smokeless  and  which  yields  a 
high  degree  of  heat. 

The  following  strengths  of  alcohol  also  are  official,  with  whisky  and 
brandy,  which  are  strong  alcoholic  liquors: 

Alcohol  Absolutum  (not  less  than  99  per  cent,  by  weight)  is  the  purest 
spirit  obtainable.  Owing  to  the  strong  affinity  which  alcohol  has  for 
water,  it  is  impossible  to  separate  them  absolutely;  but,  by  treating 
strong  alcohol  with  potassium  carbonate  and  fused  calcium  chloride, 
which  have  a  stronger  affinity  for  water,  and  redistilling,  all  except  a 
fraction  of  1  per  cent,  of  water  can  be  removed.  Absolute  alcohol  is 
equally  difficult  to  keep  in  full  strength  on  account  of  absorption  of 
moisture  from  the  air.  It  must  be  kept  in  well-stoppered  bottles  and 
exposure  to  air  avoided.  It  is  highly  inflammable.  It  is  seldom  that 
so  strong  a  spirit  is  needed,  but  it  may  be  required  for  special  uses  as 
a  solvent  and  as  a  chemical. 

Alcohol  Dilutum  (48.9  per  cent,  by  volume).  This  is  composed  approxi- 
mately of  equal  parts  of  alcohol  and  water  and  corresponds  nearly  to 
"proof  spirit"  (50  per  cent.),  which  is  the  United  States  standard 
for  measuring  unrectified   spirit. 

Spiritus  Frumenti  (whisky)  contains  from  44  to  55  per  cent,  by  vol- 
ume of  alcohol.  It  is  distilled  from  fermented  grain  and  should  be  at 
least  four  years  old. 

Spiritus  Vini  Gallici  (brandy)  contains  from  46  to  55  per  cent,  by 
volume  of  alcohol.  It  is  distilled  from  the  fermented  juice  of  grapes 
and  should  be  at  least  four  years  old.  Whisky  and  brandy  do  not  gain 
in  alcoholic  strength  by  age,  but  they  develop  flavor;  and,  in  whiskey 
particularly,  the  fusel  oil,  which  is  a  natural  impurity  of  raw  spirit, 
is  destroyed  during  the  ripening  process. 

Local  Action  and  Uses  of  Alcohol.  This  drug  is  astringent  by  virtue 
of  its  power  to  coagulate  albumin  and  to  abstract  water  from  the  tissues. 
The  coagulum  is  not  so  firm  as  that  produced  by  most  mineral  astrin= 


ASTRINGENTS  AND  HEMOSTATICS  99 

gents,  and  it  may  be  gradually  redissolved  by  the  alkaline  fluids  of  the 
tissues.  When  applied  in  the  full  strength  to  the  mucous  membrane, 
alcohol  induces  first  a  burning  sensation,  which  becomes  painful  as  the 
full  action  upon  the  tissue  is  attained.  With  its  evaporation  a  cooling 
sensation  may  then  be  experienced.  The  irritation  soon  passes  away, 
and  there  remains  a  sense  of  fulness  in  the  part,  with  corrugation  of 
the  surface,  which  at  the  same  time  has  acquired  a  whitish  appearance 
in  the  superficial  layer.  Gradually  the  mucous  membrane  will  be 
restored  to  its  normal  condition  with  very  slight  surface  exfoliation. 
The  action  is  very  superficial  and  of  only  moderate  duration.  iVlcohol, 
therefore,  cannot  rank  as  more  than  a  mild  astringent,  but  the  posses- 
sion of  the  power  to  abstract  water,  with  its  volatility,  makes  it  a  valuable 
drying  agent  wherever  apphed.  Added  its  antiseptic  quality,  we  have 
in  alcohol  an  agent  that  is  cooling  to  an  inflamed  surface,  slightly 
astringent  and  antiseptic — the  very  qualities  that  make  it  (whether 
used  pure,  diluted  or  as  a  vehicle  for  other  substances)  a  very  useful 
wash  or  application  in  stomatitis  or  any  unhealthy  state  of  the  gum  or 
mucous  membrane.  Hofheinz  advocates  the  use  of  a  mouth  wash  of 
alcohol  1  part  and  water  2  parts  in  pyorrhea  alveolaris.* 

It  is  also  useful  as  a  drying  agent  in  cavities  and  root  canals;  and  if 
its  application  be  followed  by  that  of  chloroform  or  ether  a  most  perfect 
and  rapid  removal  of  moisture  will  be  effected;  the  alcohol  first  taking 
up  the  moisture,  evaporation  is  then  hastened  by  the  alcohol  being 
taken  up  by  the  more  rapidly  volatile  chloroform  or  ether.  The  only 
precaution  necessary  regarding  this  use  is  the  avoidance  of  the  proximity 
of  a  flame,  because  of  the  inflammability  of  alcohol  and  ether. 

Alcohol  is  also  a  useful  lotion  when  applied,  somewhat  diluted,  to  a 
bruised  or  inflamed  surface ;  and  if  capillary  oozing  be  present,  its  action 
will  favor  coagulation  of  blood  and  contraction  of  arterioles. 

It  must  be  said  that  alcohol  contributes  much  to  the  local  action  of 
certain  tinctures,  of  which  tincture  of  myrrh  is  an  example;  indeed,  in 
this  preparation  the  alcohol  is  much  more  important  and  active  than 
is  the  myrrh.     (See  under  Antiseptics.) 

Applied  to  the  skin,  the  action  of  alcohol  is  less  marked  than  upon 
mucous  membranes,  because  of  the  firmer  texture  of  the  former  and 
the  better  protection  it  affords  to  the  sensitive  structures  beneath. 
Rubbing  or  bathing  the  skin  with  alcohol  produces,  first,  cooling  of  the 
surface,  which  is  soon  followed  by  a  reaction  that  is  delightful. 

*  Items  of  Interest,  1905,  p.  63. 


100  LOCAL  REMEDIES 

The  power  of  attracting  moisture  gives  alcohol  a  place  as  a  remedy 
in  carbolic  acid  poisoning.  Its  action  here  is  more  upon  the  injured 
tissue  than  upon  the  poison.  (See  Phenol  Poisoning.)  The  same 
property,  plus  antiseptic  power,  makes  alcohol  a  detergent  of  some  value. 

In  addition  to  remedial  uses,  alcohol  is  employed  largely  as  a  solvent 
for  drugs,  being  the  chief  menstruum  in  fluid  extracts,  tinctures,  spirits 
and  elixirs,  besides  being  used  to  extract  many  vegetable  active  prin- 
ciples. When  selecting  an  astringent  drug  for  use,  it  follows  that  the 
tincture  of  that  drug  (if  its  solution  in  alcohol  is  possible)  will  be  espec- 
ially efficient  by  reason  of  the  added  action  of  alcohol. 

Alcohol  is  also  used  as  the  general  solvent  for  resins,  as  in  the  prepa- 
ration of  sandarach  varnish. 

The  internal  action  of  alcohol  is  considered  under  Stimulants. 

Incompatibility.  Alcohol  is  incompatible  with  albuminous  substances, 
all  of  which  are  coagulated  by  strong  alcohol.  It  precipitates  gums  from 
their  aqueous  solutions.  On  account  of  their  insolubility  in  alcohol 
many  salts  of  the  alkalies  and  metals  may  be  precipitated  by  it  from 
their  aqueous  solutions.     Chromic  acid  is  decomposed  by  alcohol. 

Methylic  Alcohol  (not  official).  Wood  Spirit  [CH4O].  A  thin 
colorless  liquid  obtained  in  the  destructive  distillation  of  wood.  It  has  a 
peculiar  odor  and  burning  taste,  sp.  gr.  0.802,  and  boils  at  151.7°  F. 
It  burns  with  a  pale,  smokeless  flame,  giving  less  heat  than  ethylic  alcohol. 
By  partial  oxidation  it  yields  formaldehyde  gas.  A  purified  product  is 
called  Columbian  Spirit.  W^ood  spirit  is  used  as  a  substitute  for  ethylic 
alcohol  as  solvent  and  for  external  uses.  Its  use  as  a  solvent  may  be 
proper,  but  its  external  application  should  be  with  caution  on  account 
of  its  poisonous  nature.* 

Coagulant  Astringents  (Mineral). 

This  group  of  drugs  stands  in  contrast  with  the  tannic  acid  group,  as 
we  might  expect  from  their  compound  chemical  nature.  They  are  com- 
pounds of  acids  with  metallic  bases,  so  that,  by  their  dissociation  in  con- 
tact with  tissues,  we  have  two  distinct  agents  concerned  in  the  action  of 
each  mineral  astringent.  This  fact  is  given  prominence  by  some  of  the  later 
authorities  in  pharmacologyf  and  its  recognition  removes  much  of  the 
difficulty  in  understanding  the  action  of  these  salts  upon  living  tissues. 
The  essentials  of  their  action  may  be  stated  as  follows :    Mineral  astrin- 

*  A  number  of  cases  have  been  reported  within  recent  years  where  blindness,  more 
or  less  permanent,  followed  prolonged  contact  with  the  fumes  of  this  drug. 
•j-  See  Cushny,  Pharmacology  and  Therapeutics,  second  edition,  p.  604. 


ASTRINGENTS  AND  HEMOSTATICS  101 

gents  have  the  property  of  precipitating  albuminous  or  proteid  sub- 
stances. This  must  be  understood  to  be  a  definite  chemical  reac- 
tion, whereby  a  metallic  albuminate  is  formed  and  the  acid  of  the  salt  is 
liberated.  There  is,  therefore,  added  to  the  coagulation  or  precipitation 
process  the  action  of  whatever  acid  is  liberated.  As  they  differ  in 
coagulant  power,  the  sum  of  the  action  of  any  one  will  depend,  as 
Cushny  states,*  upon  "two  factors — the  nature  of  the  precipitate  and  of 
the  acid.  The  latter  tends  to  exercise  the  same  astringent  or  corrosive 
effects  as  if  it  had  been  applied  uncombined,  but  its  action  may  be 
modified  by  the  presence  of  a  layer  of  metallic  albuminate  protecting 
the  surface."  The  firmer  the  coagulum  the  less  will  the  liberated  acid 
irritate  the  tissues,  and,  on  the  other  hand,  the  stronger  the  acid  liberated 
the  greater  will  be  the  possibility  of  irritation  by  it.  We  would,  therefore, 
expect  the  mineral  acid  salts  to  be  more  irritating  than  organic  acid 
salts.  This  we  find  to  be  the  case  in  comparing  the  action  of  chloride 
of  zinc  with  that  of  acetate  of  lead.  Again,  among  the  mineral 
acid  salts  those  that  are  most  easily  dissociated,  such  as  the  soluble 
chlorides  and  nitrates,  are  found  to  be  most  irritating.  A  com- 
parison of  the  chloride  and  sulphate  of  zinc  gives  evidence  of  this, 
the  chloride  being  much  more  irritating.  The  variety  of  these  mineral 
compounds  permits  of  the  selection  of  an  agent  for  any  grade  of 
action  desired. 

The  group  of  astringent  iron  salts  in  common  use  comprise  the  follow- 
ing, all  of  which  are  acid  in  reaction: 

Ferri  Chloridum.  Ferric  Chloride  [FeCl3  +  6H20].  An  orange- 
yellow,  crystalline  salt,  with  a  strongly  astringent  taste.  Very  deli- 
quescent in  moist  air  and  freely  soluble  in  water  and  in  alcohol.  It 
contains  not  less  than  20  per  cent,  of  iron.  Used  chiefly  in  the  two 
following  preparations: 

Tinctura  Ferri  Chloridi.  Tincture  of  Ferric  Chloride.  Contains 
about  4.6  per  cent,  of  metallic  iron.     Dose,  ttlS  to  30  (gm.  0.30-2). 

Liquor  Ferri  Chloridi.  Solution  of  Ferric  Chloride.  Contains 
about  10  per  cent,  of  metallic  iron. 

Ferri  Sulphas.  Ferrous  Sulphate.  Copperas.  Green  Vitriol 
[FeSo,+  7H,0]. 

Ferri  Sulphas  Exsiccatus.    Dried  Ferrous  Sulphate. 

Ferri  Subsulphas  (not  official).  Basic  Ferric  Sulphate.  MonseVs 
Salt.    The  chemical  composition  of  this  salt  is  variable. 

*  See  Cushny,  Pharmacology  and  Therapeutics,  second  edition,  p.  604. 


102  LOCAL  REMEDIES 

Liquor  Ferri  Subsulphatis.  Solution  of  Basic  Ferric  Sulphate. 
Monsel's  Solution.    Contains  13.6  per  cent,  of  metallic  iron. 

This  preparation  is  often  improperly  called  pei'sulpkate  of  iron.  The 
true  persulphate  is  a  neutral  salt,  while  this  is  basic.  The  Br.  P.  very 
properly  applies  the  term  persulphate  to  the  following  preparation: 

Liquor  Ferri  Tersulphatis.  Solution  of  Normal  Ferric  Sulphate 
[Fe2(SOj3].  This  is  properly  the  solution  of  persulphate  of  iron.  It 
contains  about  10  per  cent,  of  metallic  iron. 

Of  all  of  the  above,  the  liquor  ferri  subsulphatis  or  Monsel's  solution 
is  used  more  than  all  others  as  a  hemostatic.  It  is  objectionable  on 
account  of  the  copious,  dirty,  black  coagulum  which  it  produces;  and 
it  also  stains  any  fabric  that  it  touches.  It  is  not  an  agent  of  first  choice, 
but  is  used  rather  as  a  later  resort  when  the  milder  astringents  have 
failed.  It  is  very  efficient  even  when  largely  diluted.  As  astringents 
for  use  in  the  mouth,  the  whole  group  here  named  are  objectionable 
because  of  their  strongly  acid  reaction,  which  renders  them  deleterious 
to  the  teeth.  If  employed  at  all,  strict  precaution  should  be  taken  to 
prevent  their  contact  with  the  teeth,  and  neutralization  of  their  acidity 
should  follow  their  use.  A  solution  of  sodium  bicarbonate  is  a  useful 
alkali  for  the  latter  purpose.  Hemostatic  cotton  is  prepared  by  satu- 
rating absorbent  cotton  with  either  Monsel's  solution  or  solution  of 
ferric  chloride,  and  drying. 

It  should  be  remembered  that  not  all  iron  preparations  affect  the 
teeth.  They  all  may  form  iron  sulphide  in  a  foul  mouth  or  carious 
cavity,  with  a  resulting  stain,  but  only  those  that  have  an  acid  reaction 
are  destructive  to  the  tooth  structure.  All  astringent  iron  salts  are 
acid,  but  for  internal  administration  there  are  a  number  of  neutral 
preparations  that  are  harmless.  (For  reactions,  solubility  and  general 
uses  of  the  iron  salts,  see  Index  of  Drugs.) 

Incompatibility.  Ferric  salts  in  solution,  with  alkalies  or  alkaline 
carbonates  in  excess,  produce  a  brown  precipitate  of  ferric  hydrate. 
With  tannic  acid,  tannate  of  iron  (black  ink)  is  formed. 

FerroMS  salts  with  oxidizing  agents  are  converted  into  ferric  salts. 
With  alkalies  and  alkaline  carbonates,  solutions  of  ferrous  salts  yield 
precipitates.  Tannic  acid  produces  no  change  in  ferrous  salts  in  the 
absence  of  oxygen. 

Alumen.  Alum.  Aluminium  and  Potassium  Sulphate  [A1K(S04)2+ 
I2H2O].  This  substance  is  potassium-alum  as  distinct  from  ammo- 
nium-alum, which  was  formerly  official.  It  occurs  in  colorless  crystals 
having  an  astringent  taste  and  acid  reaction.    Soluble  in  9  parts  of  cold 


Astringents  and  hemostatics  103 

water,  0.3  part  of  boiling  water,  freely  soluble  in  warm  glycerin,  but 
insoluble  in  alcohol.  It  coagulates  albumin,  acting  superficially  as  an 
astringent  and  hemostatic.  To  check  slight  hemorrhages  the  pure 
crystal  or  strong  solution  may  be  applied.  For  nose-bleed  a  nasal 
irrigation  or  injection  of  the  solution  as  hot  as  can  be  borne  is  useful. 
The  aqueous  solution  may  be  used  in  any  strength  as  a  gargle  or  wash, 
but,  being  acid  in  reaction,  it  is  not  admissible  as  a  mouth  wash  for 
continuous  use.     In  large  dose  the  drug  is  emetic. 

WTien  alum  is  subjected  to  a  high  degree  of  heat  it  loses  its  water  of 
crystallization  and  becomes  opaque  and  amorphous.  It  is  then  known 
as  dried  alum  falumen  exsiccatum)  or  "  burnt  "  alum,  and  is  more 
energetic  in  its  action  upon  tissue,  being  even  escharotic  to  loosely 
organized  tissue. 

Incompatibility.  Alumen  is  incompatible  with  alkalies  and  their 
carbonates.  With  metals  soluble  in  dilute  sulphuric  acid  the  aqueous 
solution  of  alum  will  liberate  hydrogen. 

Argenti  Nitras.  Nitrate  of  Silver  [AgNOg].  This  drug  is  described 
and  discussed  quite  fully  in  the  chapter  upon  Escharotics.  As  an 
astringent  it  is  used  upon  mucous  membranes  in  conditions  of  relaxation 
or  of  chronic  catarrh,  such  as  chronic  pharyngitis,  where  the  dilated 
capillaries  give  evidence  of  a  decided  loss  of  tone  in  the  mucous  mem- 
brane. The  indications  here  are  for  a  drug  that  will  cause  condensa- 
tion of  the  relaxed  tissue  with  contraction  of  the  dilated  vessels.  Nitrate 
of  silver  is  one  of  our  best  agents  to  accomplish  this,  when  applied  in 
solution  of  from  1  to  5  per  cent.,  the  stronger  solutions  being  commonly 
used  with  an  atomizer.  It  is  irritating,  but  superficial  in  its  action.  It 
coagulates  albumin.  Its  irritant  action  is  explained  in  part  by  the  liber- 
ation of  nitric  acid  at  the  time  of  its  coagulant  action,  albumin  taking 
the  place  of  the  acid  in  the  combination.  In  connection  with  the 
application  of  this  drug  it  may  be  remarked  that  a  catarrhal  condition 
does  not  need  a  constant  irritant.  The  restoration  of  the  vascular 
tone  will  occur  slowly  under  the  influence  of  a  decided  local  stimulant 
applied  not  too  frequently.  For  the  best  effect,  therefore,  nitrate  of 
silver  should  not  be  applied  oftener  than  once  a  day  or  once  in  two 
days.  In  general,  any  strength  of  solution  may  be  used  up  to  5  per 
cent.,  although  this  strength  is  decidedly  irritating.  Any  excessive 
action  may  be  prevented  by  promptly  neutralizing  with  a  solution 
of  sodium  chloride.  This  drug  cannot  be  used  in  a  mouth  wash  nor 
upon  visible  surfaces,  because  it  blackens  tissues  and  fabrics  wherever 
it  touches  and    may  stain    tooth   structure.     The  solutions   of    silver 


'204  LOCAL  REMEDIES 

nitrate  are  neutral.  As  a  rule  it  is  not  prescribed  in  combination  witli 
other  substances. 

Cupri  Sulphas.  Sulphate  of  Copper.  Blue  Vitriol  [CuSO^  +  oH^O]. 
This  substance  occurs  in  bkie  crystals  of  a  raetahic,  nauseous  taste, 
sohible  in  2.2  parts  of  -^"ater  and  in  3.5  parts  of  glycerin,  but  almost 
insoluble  in  alcohol.  The  solution  is  acid  in  reaction.  It  coarjulates 
albumin.  It  ranks  Avith  silver  nitrate  as  an  irritating  astringent,  being 
even  a  mild  caustic  when  used  in  the  form  of  crystal  or  strong  solution. 
The  acid  liberated  in  connection  with  its  coagulant  action  is  sulphuric, 
one  of  the  most  irritating  of  acids.  Its  value  in  dental  practice  is  hmited, 
beino-  useful  for  limited  application  where  a  decided,  though  irritating, 
astrino-ent  effect  is  desired.  If  it  is  allowed  to  enter  a  carious  tooth 
stainino;  is  likelv  to  result. 

Internallv  the  drug  is  emetic  in  large  doses,  5  gr.  Tgm.  0.30).  In 
case  of  poisoning  by  it  albumin  is  the  best  chemical  antidote. 

Plumbi  Acetas.  Acetate  of  Lead.  Sugar  of  Lead  [Pb(C,H302)2 
+  3H,0].     (For  preparations  and  doses,  see  Index  of  Drugs.) 

Occurs  in  colorless  or  whitish  crystals  or  masses,  having  a  shght  odor 
and  sweetish,  astringent  taste.  It  is  somewhat  efflorescent,  absorbing 
carbon  dioxide  from  the  air;  soluble  in  2  parts  of  water  and  in  30  parts 
of  alcohol.  It  is  neutral  or  slightly  alkaline  in  reaction.  It  coagulates 
albumin,  being  one  of  the  active  mineral  astringents.  It  is  classed 
as  a  sedative  astringent  because  of  the  absence  of  any  marked  irritation 
from  its  application.  This  fact  agrees  T\-ith  the  explanation  that  the 
acid  of  an  astringent  salt  is  liberated  at  the  time  of  the  coagulant  action, 
being  displaced  by  the  albumin.  In  case  of  this  substance  acetic  acid 
is  liberated,  which  in  its  dilute  form  is  not  irritating.  V.lien  used  inter- 
nally this  drug  presents  the  danger  of  lead  poisoning.  Therefore,  its 
use  is  somewhat  restricted  as  to  cpantity  and  length  of  time  employed. 
In  conditions  of  denuded  surfaces,  irritable  ulcers,  and  acute  local 
inflammations  of  the  gums,  the  solution  may  be  employed,  l^ut  swal- 
lo\s'ing  the  drug  must  be  avoided.  On  account  of  this  danger  the  lead 
preparations  are  seldom  used  internally,  and  even  their  external  appli- 
cation to  large  surfaces  may  induce  poisoning.  For  local  use  a  simple 
solution  of  the  salt  in  water  or  alcohol,  or  the  official  solutions  of  the 
subacetate,  may  be  employed.  The  latter  contain  a  considerable  amount 
of  oxide  of  lead,  which  is  soluble  in  a  solution  of  the  acetate  with  a  change 
of  the  latter  to  the  subacetate.  The  official  dihited  solution,  known  as 
lead-water,  is  of  proper  strength  for  ordinary  use;  or  a  stronger  applica- 
tion mav  be  obtained  bv  diluting  the  stronger  solution,  which  is  known 


ASTRINGENTS  AND  BEMOSTATICS  105 

as  Goulard's  extract.  A  favorite  application  with  some  is  the  lead  and 
opium  wash,^  but  the  addition  of  the  tincture  of  opium  can  contribute 
very  httle  to  the  local  action  of  the  combination,  except  the  astringent 
action  of  the  alcohol  it  contains,  as  it  is  well  known  that  opium  has 
no  appreciable  local  action. 

Among  the  evidences  of  saturation  of  the  system  by  lead,  there  is 
noticed,  especially  in  foul  mouths,  a  blue  line  within  the  gum  close  to 
the  margin.  This  is  believed  to  be  a  deposit  of  lead  sulphide  within 
the  tissue,  and  it  is  indicative  of  chronic  lead  poisoning  only.  (For 
symptoms,  etc.,  of  acute  poisoning,  see  Table  of  Poisons  and  Antidotes.) 

Incompatibility.  Acetate  of  lead  is  incompatible  with  most  acids 
which  displace  the  acetic  acid,  with  iodide  of  potassium  and  with  liquor 
iodi  compositus.  The  solution  of  the  subacetate  will  precipitate  solu- 
tions of  acacia. 

Zinci  Chloridum.  Chloride  of  Zinc  [ZnClj].  This  substance  is 
used  more  as  an  escharotic  and  antiseptic,  but  in  the  weaker  solutions 
(1  to  10  per  cent.)  it  is  astringent.  It  coagulates  albumin,  but  on  account 
of  the  hydrochloric  acid  liberated  the  application  of  a  strong  solution 
is  painful,  and  it  is  also  quite  penetrating.     It  is  acid  in  reaction. 

Zinci  Sulphas.  Sulphate  of  Zinc.  White  Vitriol  [ZnSO^  +  THjO]. 
Occurs  in  colorless  crystals,  having  an  astringent,  metallic  taste,  soluble 
in  0.53  part  of  water  and  in  3  parts  of  glycerin;  insoluble  in  alcohol. 
It  is  acid  in  reaction.  It  is  one  of  the  feebler  astringents,  well  adapted 
to  the  more  sensitive  mucous  membranes,  as  the  conjunctiva  of  the 
eye.  In  acute  conjunctivitis  and  in  acute  disease  of  the  antrum,  it  is  a 
useful  astringent  in  1  per  cent,  solution.  About  the  mouth  it  may  be 
used  stronger,  as  it  is  not  irritating  to  the  oral  mucous  membrane.  In 
a  dose  of  10  to  30  grains  (gm.  0.60-2)  it  is  a  reliable  emetic,  and 
is  frequently  employed  to  empty  the  stomach  in  cases  of  poisoning. 
It  coagulates  albumin. 

Incompatibility.  Sulphate  of  zinc  is  incompatible  with  alkalies  and 
their  carbonates  and  with  ammonium  sulphide. 

Zinci  lodidum.  Iodide  of  Zinc  [ZnlJ.  This  salt  occurs  as  a  white 
powder,  having  a  sharp  taste,  very  deliquescent,  and  becoming  brown 
upon  exposure  from  the  liberation  of  iodine.     It  is  freely  soluble  in 

*  Lotio  plumbi  et  opii  (N.  F.): 

Gm.  or  c.c. 

R . — Plumbi  acetatis,  17  5 

Tincturse  opii,  35 

Aquae,  q.  s.  ad         10001       — M. 


\QQ  LOCAL   REMEDIES 

water  and  alcohol,  and  is  acid  in  reaction.  Its  action  is  chiefly  altera- 
tive combined  with  the  characteristic  action  of  the  zinc  ion.  Dr.  E.  S. 
Talbot,  after  considerable  experience  with  it,  advises  its  use  in  inter- 
stitial gingivitis  in  the  following  combination  with  iodine,  to  which  he 
gives  the  name  of  lodo-glycerole : 


Gm. 

or  c.c. 

R. 

— Zinci  iodidi, 

15 

(3iv) 

Aqu£e, 

10 

(fSijss) 

lodi, 

25 

(5vi) 

Glycerini, 

50 

(fjxiiss)— M, 

Sig. — Apply  to  gums  every  second  day. 

His  purpose  in  using  the  zinc  iodide  is  to  increase  the  strength  of  the 
preparation  and  to  make  it  more  astringent. 

Vascular  Astringents. 

An  important  group  of  hemostatics  comprises  those  whose  chief  action 
is  upon  the  bloodvessels.  The  term  styptic  is  often  used  to  designate 
these.  Either  by  local  action  when  directly  applied,  or  by  stimulating 
the  vasomotor  nerve  influence,  they  induce  contraction  of  the  mus- 
cular coat  of  the  smaller  arterial  vessels,  thus  favoring  coagulation  by 
lessening  the  capillary  circulation.  They  do  not  coagulate  albumin. 
They  are  applicable  only  in  hemorrhages  of  the  smallest  vessels,  and 
particularly  those  in  which  unstriped  muscle  tissue  is  sufficiently 
abundant  to  be  a  factor  in  controlling  the  blood  supply;  for  these 
agents  act  only  through  direct  or  indirect  stimulation  of  the  layer  of 
unstriped  muscle  in  the  wall  of  the  vessel.  Where  this  is  deficient,  as 
in  bone,  they  are  likely  to  be  inferior  to  coagulant  agents.  Those  that 
act  locally  are  of  greatest  importance  to  the  dental  practitioner  and  will 
accordingly  be  first  considered. 

Antipyrina.  Phenazone  [CgH5(CH3)2C3HN20].  This  substance  is 
obtained,  by  a  series  of  chemical  reactions,  from  pyrrol,  a  base  found 
in  coal-tar.  Chemically  it  is  phenyldimethylpyrazolon,  which  term 
shows  the  impracticability  of  using  the  chemical  names  of  many  of  the 
newer  drugs.  Classed  generally  as  an  antipyretic  and  analgesic,  it  was 
among  the  first  of  the  coal-tar  derivatives  introduced  to  medicine.  It 
occurs  in  colorless  crystals,  having  a  bitter  taste,  neutral,  soluble  in 
less  than  1  part  of  water  and  in  1  part  of  alcohol,  freely  soluble  in 
chloroform  and  in  30  parts  of  ether.    It  is  not  a  coagulant. 

Its  hemostatic  value  is  purely  local.  If  applied  or  sprayed  upon  a 
bleeding  surface,  in  the  strength  of  10  per  cent,  solution,  it  has  the  power 


ASTRINGENTS  AND  HEMOSTATICS  ]^07 

to  cause  contraction  of  the  arterioles,  and  in  this  way  will  efficientlv 
control  any  ordinary  capillary  hemorrhage.  It  w\\\  be  less  efficient  than 
a  coagulant  hemostatic  in  checking  hemorrhage  from  a  tooth  socket, 
because  of  the  deficiency  of  muscle  in  the  vessel  walls  in  bone.  It  is 
a  harmless  drug  when  applied  as  above,  for  one-half  of  a  fluidounce 
(15  c.c.)  of  a  10  per  cent,  solution  may  be  used  T\'ithout  exceeding  the 
internal  adult  dose.  It  is  useful  in  stopping  epistaxis  (nose-bleed),  the 
solution  being  sprayed  into  the  nostril. 

Its  uses  as  anodyne  and  sedative  are  discussed  in  another  place. 

Incompatibility.  The  aqueous  solution  is  incompatible  \s'ith  a  dilute 
solution  of  carbolic  acid;  also  with  spirit  of  nitrous  etlier  when  the  latter 
is  acid,  as  it  is  likely  to  be  ordinarily. 

Adrenalin.  This  name  is  applied  to  a  preparation,  possibly  the 
single  active  principle,  obtained  from  the  suprarenal  glands  of  the 
sheep  or  ox.  It  is  claimed  to  be  a  definite  crystalline  substance,  and  is 
used  in  the  form  of  adrenalin  chloride,  which  is  obtainable  in  the  strength 
of  1 :  1000  in  normal  saline  solution.  It  may  be  used  in  this  strength 
or  diluted.  It  does  not  coagulate  albumin.  x\s  a  hemostatic  its  action 
is  local  upon  the  muscle  tissue  of  the  arterioles,  causing  constriction 
of  the  vessels.  WTiile  some  effect  may  be  obtained  by  its  h}"podermic 
use,  and  still  more  by  its  intravenous  injection,  it  being  carried  in  the 
circulation  to  the  bleeding  point,  the  tisual  and  best  means  of  employ- 
ing it  is  by  local  application  to  the  part.  Hemorrhages  from  small 
vessels  or  from  the  capillaries  are  best  controlled  by  it.  For  checking 
epistaxis  or  hemorrhage  follovving  slight  operations  it  is  very  efficient. 

Adrenalin  is  coming  into  favor  as  a  heart  stimulant  in  cases  of  shock 
and  collapse,  in  which  relation  it  is  considered  under  Stimulants. 

Epinephrine  is  regarded  as  an  alkaloid  from  the  same  source  as 
adrenalin,  and  it  possesses  similar  properties. 

Cocaine  Hydrochloride. 

Hydrogen  Dioxide  (3  per  cent.). 

Both  of  these  agents  possess  some  st}^tic  power,  but  this  is  incidental 
to  their  more  prominent  action.  They  may  be  applied  for  the  purpose 
of  controllino;  hemorrhage  locallv,  their  influence  being  entirelv  through 
stimulation  of  vascular  constriction.  Neither  of  them  coagulates 
albumin.  When  employed  as  styptics  the  same  strengths  of  solutions 
are  applied  as  for  their  main  uses,  but  with  cocaine  hydrochloride  due 
precaution  must  be  taken  to  avoid  poisoning. 

Acidum  Gallicum.  Gallic  Acid  [HC.HjOg  +  H^O].  An  organic 
acid,  prepared  from  tannic  acid,  having  a  rather  uncertain  reputation 


108  LOCAL   REMEDIES 

as  a  general  st^'ptic — i.  e.,  acting  throughout  the  system  after  absorption 
into  the  circulation.  It  occurs  in  whitish  crystals,  having  an  astringent 
taste,  soluble  in  S3. 7  parts  of  water,  in  about  5  parts  of  alcohol,  and  in 
12  parts  of  glycerin.  It  is  acid  in  reaction.  It  does  not  coagulate  albumin, 
therefore  it  has  no  appreciable  local  action.  It  may  be  giyen  intenially 
in  a  dose  of  from  5  to  20  grains  (0.30-1.30  gm.).  It  is  not  much 
to  be  rehed  upon,  still  it  is  recommended  by  some  in  the  hemorrhagic 
diathesis  and  to  control  internal  hemorrhages  that  cannot  be  reached 
by  local  medication. 

Ergota.  Ergot  of  Rye.  This  fungus,  which  replaces  indi^•idual 
seeds  of  the  grain,  is  sometimes  called  "spurred  rye."  The  pieces  are 
one-half  to  one  inch  long,  fusiform,  slightly  curved,  purplish-black, 
hard,  and  breaking  transyersely. 

Uses  as  a  Hemostatic.  Ergot  has  no  local  action.  The  drug  is 
useful  onlv  as  it  induces  contraction  of  inistriped  muscle  after  entering 
the  circulation.  Capillary  hemorrhages  that  cannot  be  treated  locally 
call  for  its  administration  by  stomach  or,  in  emergency,  h}-podermically. 
The  fluidextract  is  the  preparation  most  commonly  employed,  in  doses 
of  j-1  fluidrachm  1 1-4  c.c).  In  hemophilia  (hemorrhagic  diathesis) 
it  is  one  of  the  drugs  recommended.  It  should  never  be  used  in  case 
of  hemorrhage  from  a  good-sized  vessel,  for  fear  of  increasing  the  flow 
through  the  rise  of  arterial  pressure  which  the  drug  produces.  (Plate  I.) 

It  is  the  drug  of  all  drugs  for  the  control  of  post-partum  hemorrhage. 
This  dangerous  complication  after  labor  is  due  to  relaxation  of  the 
unstriped  muscle  which  is  so  abundant  in  the  parturient  uterus.  Ergot 
stimulates  this  to  powerful  contraction,  thereby  closing  up  the  uterine 
sinuses  from  which  the  bleeding  has  occurred. 

Remedies  that  Favor  Coagulation  of  the  Blood  by  Reducing 
Blood  Pressure. 

Besides  the  application  of  cold,  which  has  been  considered  in  the 
earlier  part  of  the  chapter,  there  are  several  agents  which  comprise 
the   group   of   arterial  sedatives.    The  most  prominent  of  these  are : 

Aconitum.  The  root  of  Aconitum  napellus.  The  tincture  is  the 
preparation  commonly  used,  the  dose  of  which  is  .5-15  minims  (0.30- 
1  gm.).     For  its  precise  action,  see  Plate  XIV.,  under  Sedatives. 

Veratrum.  The  root  of  Veratrum  viride.  This  drug  is  so  similar  in 
action  and  uses  to  aconite  as  to  recjuire  no  special  discussion  here.  The 
dose  of  the  tincture  is  5-20  minims  ( 0.30-1.20  gm.J. 


PLATE    I. 


ERGOT. 

A  fungus  replacing  the  grain  of  rye. 

[For  preparations  and  doses,  see 
Index  of  Drugs.] 

Classified  as  : 
Oxytocic. 

Vasoconstrictor. 
Hemostatic. 


Physiologic  action  : 
Digestive  Tract. 

It  is  believed  to  stimulate 
gastric  motility  and  intes- 
tinal peristalsis. 

Nervous  System. 

Brain.     Not  affected. 

Medulla.  Stimulates  vaso- 
motor centre. 

Spinal  cord.  Stimulates 
centre  for  uterine  contrac- 
tion in  lower  part  of  cord. 

Muscular  System. 

Stimulates  unstriped  muscle, 
— noted  especially  in  the  ar- 
terioles and  gravid  uterus. 
The  vasoconstrictor  effect, 
and  the  consequent  inter- 
ference with  the  capillary 
circulation,  are  so  decided, 
that  gangrene  may  result 
from  its  prolonged  use. 

Circulation.  Arterial  pressure 
is  increased. 

Heart.  May  be  slowed,  but 
influence  not  definite. 

Capillary  area.  Arterioles 
contracted  chiefly  by  cen- 
tral vasomotor  stimulation. 

Uterus.  Stimulates  uterine  con- 
tractions, mainly  by  influ- 
encing centre  in  lower  part 
of  spinal  cord. 


C  erebrum 


Pons  V       Cci'ebellu'in 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Symjpathetic 


Solar  Plexus 


Pelvic  Plexus 


Eed  color  indicates  stimulation. 


ASTRINGENTS  AND   HEMOSTATICS  109 

Remedies  that  Increase  the  Coagulant  Property  of  the  Blood. 

Within  recent  years  there  has  been  a  decided  gain  in  our  resources 
for  treating  cases  of  persistent  hemorrhage  due  to  various  causes,  which 
present,  as  an  important  factor,  deficient  coagulation  of  the  blood.  The 
remedies  employed  may  not  all  act  in  the  same  way,  but  each  has  been 
sufficiently  successful  to  entitle  it  to  trial  in  any  severe  hemorrhage  and 
particularly  in  cases  of  hemophilia.  Certain  calcium  salts  have,  indeed, 
fully  proved  their  efficiency. 

Calcii  Chloridum.  Chloride  of  Calcium  [CaCb].  [Do  not  con- 
fuse with  chloride  of  lime,  a  chlorine  disinfectant  and  bleaching  agent.] 

Chemically  pure  calcium  chloride  occurs  in  hard  white  fragments, 
which  are  deliquescent  and  have  a  sharp,  saline  taste.  It  is  neutral, 
soluble  in  1.3  parts  of  water  and  in  8  parts  of  alcohol.  When  given 
internally  it  is  believed  to  increase  the  coagulability  of  the  blood.  Good 
reports  have  been  made  of  its  value  in  hemophilia,  used  both  locally 
and  internally.  The  dose  is  5-10  grains  (0.30-0.60  gm.)  every  four  or 
six  hours,  or  a  smaller  quantity  more  frequently.  For  local  application 
a  5  or  6  per  cent,  solution  in  water  has  been  employed.  Parry  *  reports 
a  case  of  hemophilia  in  which  a  persistent  and  alarming  hemorrhage 
from  the  gums  was  checked  by  the  local  application  of  a  6J  per  cent, 
solution  (30  grains  to  the  fiuidounce).  This  drug  certainly  deserves  a 
trial  in  any  case  of  persistent  hemorrhage. 

Calcium  Lactate  (not  official)  is  less  soluble  than  the  chloride,  but, 
for  prolonged  use,  is  better  tolerated  by  the  stomach.  The  dose  is  the 
same  and  in  efficiency  in  treating  hemorrhage  it  seems  to  be  equal  to  it. 

Gelatin.  A  sterilized  solution  of  gelatin  in  water,  or  in  normal  salt 
solution,  is  employed  either  subcutaneously  or  by  rectum.  For  subcu- 
taneous injection  a  2  per  cent,  solution  is  used  in  quantities  varying  from 
2  fluidounces  (60  c.c.)  for  a  child,  up  to  8  fluidounces  (240  c.c.)  for  an 
adult,  repeated  as  the  case  may  require.  For  rectal  injection  4  to  8  fluid- 
ounces  (120-240  c.c.)  of  a  5  per  cent,  solution  may  be  used. 

Thyroid  Gland.  Both  the  extract  of  the  thyroid  gland  of  the  sheep 
or  of  other  domestic  animals,  and  the  dried  gland  substance  itself,  have 
given  such  striking  results  in  the  treatment  of  myxedema,  that  its 
administration  has  been  resorted  to  experimentally  in  many  conditions. 
Especially  in  disorders  of  nutrition  and  in  diseases  of  the  circulating 
fluids,  where  absence  of  the  thyroid  secretion  might  be  a  causative 

*  Lancet,  February  21,  1903. 


110  LOCAL  REMEDIES 

factor,  this  substance  has  been  tried.  Regarding  its  value  in  hemophilia, 
a  very  satisfactory  result  is  reported  of  a  case  by  Fuller.*  The  patient 
was  a  boy  fifteen  years  old.  Four  maternal  uncles  and  two  elder  brothers 
had  bled  to  death.  The  patient  had  frequent  copious  hemorrhages 
from  the  nose  and  also  bled  severely  with  the  loss  of  ternpor^r;.'  rri-Th. 
For  a  year  he  had  been  in  a  very  weak  condition  cause^i  by  sponiaii'^^ous 
attacks  of  hemorrhage  from  the  kidneys.  After  failure  with  the  usual 
remedies,  5  grains  (0.30  gm.)  of  thyroid  extract  were  given  three  times 
daily.  After  the  second  dose  the  bleechng  ceased.  The  case  was 
reported  nine  months  after,  during  which  time  there  had  been  no 
recurrence  of  hemorrhage. 

While  the  cases  noted  above  are  convincing,  it  must  be  said  that 
experience  with  a  large  number  of  cases  will  be  necessary  before  the 
extent  of  the  usefulness  of  this  group  of  drugs  can  be  determined. 

Remedies  that  Cause  Direct  Pressure  or  Occlusion  of  Vessels. 

Mechanical  Hemostatics.  Under  this  hea'hng  are  included  surgical 
measures,  such  as  pressure,  hgatures  and  torsion.  Pressure  may  be 
made  directly  upon  the  bleeding  point,  or  upon  the  artery  of  supply  at 
some  near  point  where  it  may  be  more  effectually  applied.  Ligatures 
are  intended  to  completely  occlude  the  bleeding  vessel,  leading  to  its 
obhteration  beyond.  Torsion  means  twisting  of  a  vessel.  Small  vessels 
that  are  not  easily  hgated  may  be  treated  in  this  way. 

In  case  of  persistent  bleeding  after  extraction  of  a  tooth,  the  most 
effectual  remedy  is  pressure,  for  the  apphcation  of  which  the  tooth 
socket  and  the  occluding  jaw  opposite  are  well  arranged.  A  cork  may 
be  shaped  with  the  knife  and  file  to  conform  to  the  root  of  the  extracted 
tooth,  and,  after  sterilization  by  boihng,  inserted  into  the  l:>leei;ling 
socket.  It  is  also  recommended  that  warm  wax  or  modehug  compjuml 
be  first  inserted  and  the  cork  pressed  into  it.  A  rather  simpler  method 
will  be  to  roll  hemostatic  cotton  firmly  into  a  cone  of  proper  size  to  fit 
the  socket  tightly.  This  wiU  aid  by  direct  coagulant  action,  though  the 
cotton  plug  ^dll  be  less  sohd  than  a  cork.  After  insertion  a  cork  or 
firm  pad  of  gauze  is  placed  between  the  plug  occupying  the  socket  and 
the  opposing  jaw,  or  the  teeth  contained  in  it,  so  as  to  have  r>:>  —  iv  i;  f  the 
necessary  degree  exerted  by  closiu'e  of  the  jaws.  The  pres-  r^  i-  usually 
maintained  by  a  bandage  passing  under  the  lower  jaw  am  aijuut  the 
head. 

*  Medical  News,  Februarv  2S,  1903. 


ASTRINGENTS  AND  HEMOSTATICS  111 

The  collodion  group  act  chiefly  by  exerting  pressure.  They  are  all 
highly  inflammable,  and  must  not  be  handled  in  the  vicinity  of  a  flame. 

Collodium.  Collodion.  A  varnish  that  consists  of  a  solution  of 
4  parts  of  pyroxylin  in  75  parts  of  ether  and  25  parts  of  alcohol.  It  is 
applied  by  means  of  a  camel's  hair  brush  upon  a  thoroughly  dried 
surface.  By  rapid  evaporation  of  the  liquids  its  volume  contracts,  and 
considerable  pressure  is  exerted  upon  the  underlying  tissue.  It  is 
applicable  only  to  slight  superficial  hemorrhages. 

Incompatibility.     Collodion  is  precipitated  by  carbolic  acid. 

Collodium  Flexile.  Flexible  Collodion.  In  this  preparation  5  parts 
of  Canada  balsam  and  3  parts  of  castor  oil  are  added  to  92  parts  of 
collodion.  Its  flexible  character  adapts  it  to  use  over  movable  parts, 
such  as  the  lips,  or  about  a  joint. 

Collodium  Stypticum.  Styptic  Collodion.  In  this  the  formula  is 
modified  so  as  to  contain  20  per  cent,  of  tannic  acid,  which  adds  coag- 
ulant power  and  furnishes  a  more  powerfully  styptic  combination. 


The  class  of  hemostatics  would  not  be  sufficiently  discussed  without 
mention  of  a  drug  not  usually  included  in  the  class,  but  one  that  is 
nevertheless  valued  highly  in  its  distinct  application  to  cases  of  hemor- 
rhage. 

Opium.  (For  description  and  detailed  action,  see  under  Sedatives.) 
This  drug,  of  general  systemic  action,  is  mentioned  here  only  for  its 
value  in  aiding  to  restrain  certain  kinds  of  hemorrhage.  It  cannot  be 
classed  with  any  of  the  preceding  drugs,  for  it  has  neither  coagulant  nor 
vasoconstrictor  action;  but  it  is  by  its  power  to  put  the  system  at  rest 
that  it  becomes  so  valuable  in  the  treatment  of  internal  hemorrhages. 
Bleeding  from  the  lungs  requires  that  cough  be  restrained  and  respira- 
tory excitement  allayed ;  intestinal  hemorrhage  requires  that  the  bowel 
be  held  quiet;  and  in  either  case  mental  excitement  and  apprehension 
must  be  removed.  Opium,  or  its  alkaloid,  morphine,  will  accomplish 
all  of  this.  In  fact,  the  element  of  nervous  excitement  may  aggravate 
almost  any  kind  of  bleeding  and  call  for  the  use  of  opium  or  morphine 
for  its  removal.  Morphine  in  moderate  dose  is  usually  employed,  by 
stomach  or,  if  the  case  is  urgent,  hypodermically. 


CHAPTEH  X. 

DETERGENTS,  ANTACIDS  AND  ALKALIES. 

DETERGENTS. 

The  term  detergent,  meaning  a  cleansing  agent,  applies  rather  to  one 
of  several  uses  to  which  certain  agents  are  put.  These,  in  their  more 
important  designation,  are  usually  alkalies  or  antiseptics.  Therefore, 
it  seems  unnecessary  to  make  a  separate  class  of  detergents.  Many  of 
the  alkalies  and  milder  antiseptics  are  well  adapted  to  the  cleansing 
of  the  mouth,  teeth,  throat  and  nasal  chambers,  while  the  stronger 
disinfectants  and  even  corrosive  agents  are  adapted  to  the  cleansing 
of  foul  ulcers,  putrescent  pulp  canals,  etc.  For  the  former  uses,  agents 
that  do  not  coagulate  albumin  will  be  most  useful,  for  a  certain  degree 
of  penetration,  especially  into  the  recesses  between  the  teeth,  is  desirable, 
which  might  be  hindered  by  coagulation.  For  the  latter  uses,  destruction 
of  diseased  tissue,  bacteria  and  decayed  matter  is  necessary,  calling  at 
times  for  the  strongest  chemical  drugs.  Again,  in  dentifrices  one  kind 
of  detergent  is  that  which  contributes  the  scouring  quality,  as  prepared 
chalk;  another  kind,  that  which  will  thoroughly  cleanse  all  surfaces, 
as  soap;  and  still  another  may  be  desired  to  exert  a  solvent  or  a  pene- 
trating influence.  Hydrogen  peroxide  is  a  very  important  detergent 
besides  being  an  antiseptic.  Its  action  is  a  double  one.  First,  upon 
coming  into  contact  with  blood,  pus,  or  loosely  organized  tissue,  it  is 
decomposed,  yielding  nascent  oxygen,  by  which  it  acts  as  an  oxidizing 
agent  and  antiseptic.  Second,  the  freeing  of  oxygen  causes  gaseous 
expansion,  by  which  foul  materials  may  be  loosened  and  carried  away 
from  the  tissues  mechanically. 

ANTACIDS  (ALKALIES). 

Antacids  are  agents  that  are  capable  of  neutralizing  acids  by  reason 
of  either  their  alkaline  or  basic  properties.  Alkalies  are  known  by  their 
power  of  changing  the  color  of  red  litmus  to  blue. 

(112) 


DETERGENTS,  ANTACIDS  AND  ALKALIES  113 

The  action  of  antacids  is  always  chemical,  for  the  acid  character  of 
a  substance  is  lost  only  through  combination  or  decomposition.  In 
some  instances,  where  a  simple  alkali  is  used,  such  as  lime-water  or 
magnesia,  the  chemical  change  is  a  simple  one,  while  with  the  use  of 
sodium  bicarbonate  or  prepared  chalk,  there  is  decomposition  with 
evolution  of  carbon  dioxide,  and  new  combinations  result  in  which  the 
acid  quality  is  lost. 

The  importance  in  dentistry  of  the  various  substances  belonging  to 
this  class  is  readily  appreciated.  With  the  tendency  toward  acidity  of 
the  fluids  of  some  mouths;  with  the  vitiation  of  the  same  in  disease; 
and  with  the  very  common  presence  of  fermentation  in  food  particles 
which  are  allowed  to  remain  between  the  teeth,  we  have  factors  of 
prime  importance  in  the  causation  of  caries;  and  in  the  recognition  of 
these  factors  we  have  also  the  basis  upon  which  to  found  our  prophy- 
laxis. The  judicious  use  of  antacids  becomes  a  necessity,  at  least  for 
the  purpose  of  meeting  temporary  conditions,  recognizing,  however, 
that  proper  care  of  the  teeth  requires  also  proper  care  of  the  individual 
as  to  general  health  and  all  nutritive  processes. 

As  a  rule  that  scarcely  admits  of  exception,  all  mouth  washes  for 
continued  use,  and  all  dentifrices,  should  be  alkaline  or  antacid;  but 
in  the  prevention  of  caries  we  recognize  that  antacids  per  se  do  but  one 
thing — they  neutralize  acids.  The  prevention  of  acid  formation  is 
equally  important,  and  involves,  besides  strict  local  cleanliness,  the 
use  of  an  antiseptic  to  arrest  fermentation,  which  is  the  very  common 
source  of  the  acid,  or  the  use  of  an  agent  that  is  both  antacid  and  anti- 
septic. Furthermore,  when  acidity  of  the  oral  secretions  persists  in 
spite  of  local  treatment,  the  condition  of  the  general  system  must  be 
considered,  particularly  as  to  disorders  of  digestion  or  errors  of  diet, 
which  may  be  the  cause  of  the  condition. 

The  difference  in  solubility  of  the  several  antacids  in  ordinary  use 
gives  them  a  wide  range  of  adaptability  in  dental  practice.  To  illustrate : 
For  the  purposes  of  a  mouth  wash  a  soluble  alkali  is  needed;  here 
sodium  bicarbonate,  lime-water  or  borax  are  applicable.  For  use  in 
the  mouth  of  a  young  child,  where  rinsing  the  mouth  is  impracticable, 
the  gelatinous  hydrated  magnesia  may  be  applied  quite  thoroughly  by 
means  of  a  cotton  swab,  or  injected  between  the  teeth  and  the  cheeks, 
where,  because  of  its  thick  consistence,  it  will  adhere  and  remain  in 
contact  for  some  time;  and,  again,  in  case  of  erosion,  where  a  soluble 
substance  would  be  rapidly  washed  away,  the  insoluble  prepared 
chalk  may  be  packed  between  and  about  the  teeth,  and  its  neutralizing 


114  LOCAL   REMEDIES 

action  will  continue  for  hours,  or  through  the  night  if  applied  at  bed- 
time = 

The  excessive  or  continuous  use  of  antacids  may  disturb  gastric  diges- 
tion to  just  the  extent  that  they  are  allowed  to  reach  the  stomach  during 
the  first  two  or  three  hours  after  meals.  During  this  time  the  natural 
acidity  of  the  gastric  juice  is  needed  and  the  entrance  of  much  alkali 
into  the  stomach  might  hinder  digestion  by  neutralizing  the  acid. 
Other^\-ise  no  harm  is  likely  to  arise  from  their  use. 

Soaps.  Soaps  are  compounds  of  the  ordinary  fat  acids  (oleic,  palmitic, 
and  stearic)  wdth  bases.  In  the  process  of  saponification,  by  boiling  a 
fat  ^dth  a  base,  the  fat  is  decomposed,  glycerin  is  set  free,  and  the  fat 
acids  combine  -^-ith  the  base.  Strictly  speaking,  all  metallic  salts  of 
oleic,  palmitic  and  stearic  acids  are  soaps ;  but  only  those  of  potassium, 
sodium  and  ammonium  are  soluble,  ^^^latever  the  consistence  of  the 
oil  or  fat  employed,  its  reaction  vdih  sodium  will  produce  a  hard  soap 
and  with  potassium  a  soft  soap.  Lrcad  plaster  is  a  familiar  example  of 
an  insoluble  soap. 

Sapo.  Soap.  ^Miite  castile  soap  is  the  kind  preferred.  It  is  prepared 
from  soda  and  olive  oil.  It  should  be  hard,  but  easily  cut  when  fresh, 
and  free  from  rancid  odor.  It  has  an  unpleasant  alkaline  taste  and  an 
alkaline  reaction.  It  is  soluble  in  water  and  in  alcohol.  It  contains 
about  21  per  cent,  of  water,  which  may  be  largely  removed  by  drjdng 
at  an  elevated  temperature,  when  the  soap  may  be  more  readily  pul- 
verized. It  is  capable  of  dissoh^ng  fats,  which  property  gives  it  its 
great  value.  ^ledicinally  it  is  alkaline  and  somewhat  antiseptic,  pos- 
sessing detergent  qualities  in  marked  degree.  Its  chief  dental  use  is  in 
dentifrices,  where,  in  powdered  form,  it  maybe  mixed  ^\dth  any  other  agent 
in  common  use.  As  soap  is  irritating  to  the  mucous  membrane,  unless 
well  diluted,  the  mixture  should  not  contain  more  than  25  or  30  per  cent. 

Colored  or  marbled  castile  soap  is  less  pure,  as  it  contains  ferruginous 
coloring  matter.  It  is  more  strongly  alkaline,  harder,  containing  only  about 
14  per  cent,  of  water,  and  is,  therefore,  more  economical  for  ordinary  uses. 

Soft  soap,  known  officially  as  sapo  mollis,  prepared  from  potassa 
and  linseed  oil,  contains  considerable  free  potassium  hydrate;  therefore 
its  alkaUnity  is  so  strong  as  to  be  irritating  to  mucous  membranes. 
It  is  used  as  a  cleansing  agent  to  the  hands  preparatory  to  sterilizing 
them  for  surgical  work. 

Incompatibility.  Soluble  soaps  are  incompatible  with  all  acids  and 
with  eartluj  and  metallic  salts;  they  are  precipitated  in  hard  water,  or 
in  a  solution  of  corrosive  sublimate,  as  an  insoluble  soap. 


DETERGENTS,   ANTACIDS  AND   ALKALIES  115 

Sodii  Bicarbonas.  Bicarbonate  of  Sodium  [NaHCOg].  A  white, 
opaque  powder,  having  a  mildly  alkaline  taste,  soluble  in  12  parts  of 
water,  insoluble  in  alcohol.     It  is  alkaline  in  reaction. 

Although  the  carbonates  of  the  alkalies  are  more  soluble  and  more 
strongly  alkaline  than  the  bicarbonates,  the  latter  are  preferred  for 
dental  uses  because  they  are  milder  and  less  unpleasant  to  the  taste. 
For  similar  reasons  the  sodium  salts  are  preferred  to  the  potassium. 
Sodium  bicarbonate  is  the  one  usually  selected  for  internal  use,  as  it 
answers  every  purpose  of  an  alkali  without  being  at  all  irritating.  In 
stomatitis  due  to  fermentative  conditions  and  in  constitutional  disorders 
that  cause  vitiated  oral  secretions,  this  drug  is  useful  used  alone  or  in 
combination  with  an  antiseptic.  As  a  mouth  wash  or  gargle  it  may 
be  used  freely  in  saturated  solution  (8^  per  cent.).  It  may  enter  into 
dentifrices  simply  as  an  alkaline  ingredient,  as  it  is  not  antiseptic  nor 
does  it  contribute  any  scouring  quality.  It  is  useful  to  neutralize,  in  the 
mouth,  any  acids  and  acid  iron  preparations,  when  such  are  taken  or 
used  about  the  mouth. 

It  is  used  also,  by  direct  application,  to  lessen  the  sensitiveness  of 
dentine  when  this  is  due  to  acidity.  Internally  the  drug  is  used  to 
neutralize  hyperacidity  in  the  stomach .  and  in  the  various  acid  intoxica- 
tions of  the  system,  such  as  rheumatism.  The  internal  dose  is  5-30 
grains  (0.30-2  gm.).  In  connection  with  sterilization  of  instruments 
by  boiling,  sodium  bicarbonate  is  oftentimes  added  to  the  water  in 
order  to  lessen  the  liability  of  rusting. 

Incom'patibility.  This  salt  is  incompatible  with  all  acids,  producing 
effervescence  with  liberation  of  carbon  dioxide.  In  solution  it  is  changed 
by  boric  acid  into  sodium  carbonate  and  borax,  with  liberation  of  carbon 
dioxide.  (If  carbonate  of  sodium  be  present,  reaction  may  occur  with 
either  magnesium  sulphate  or  mercuric  chloride  in  solution,  a  brown- 
red  precipitate  being  thrown  down.) 

Sodii  Boras.  Borate  of  Sodium.  Borax  [Nsl^B/^j  +  IO^^^]-  Occurs 
in  colorless  crystals  or  white  powder,  having  an  alkaline  taste,  soluble 
in  20.4  parts  of  water  and  in  its  own  weight  of  hot  glycerin,  insoluble  in 
alcohol.  It  is  alkaline  in  reaction,  non-irritating  to  tissues,  and  its  taste 
is  bland  and  sweetish.     The  solution  in  glycerin  is  acid  in  reaction. 

This  salt  is  really  sodium  diborate.  It  occurs  naturally  in  many 
volcanic  regions,  our  American  supply  coming  chiefly  from  Nevada 
and  California.  It  is  also  prepared  artificially  upon  a  commercial 
scale  for  the  European  market. 

In  borax  we  have  an  agent  that  is  both  alkaline  and  antiseptic,  and 


116  LOCAL  REMEDIES 

that  maybe  used  freely  in  saturated  solution  (5  per  cent.).  It  is,  there- 
fore, admirably  adapted  to  all  uses  that  call  for  a  mouth  wash  possess- 
ing the  above  qualities.  In  stomatitis  and  in  thrush  especially  it  is  a 
superior  agent.  The  latter  disease  occurs  mostly  in  young  infants  where 
a  mouth  wash  cannot  be  so  well  employed.  Here  we  may  use  a  saturated 
solution  in  glycerin,  made  by  dissolving  the  powdered  borax  in  hot 
glycerin,  which  will  insure  saturation  when  it  has  cooled.  Glycerin 
itself  is  a  preservative,  and  the  resulting  thick,  sweet  solution  may 
be  applied  by  means  of  a  swab  to  all  parts  of  the  infant's  mouth. 
Syrup  and  honey  are  inferior  as  vehicles,  because  they  ferment  readily. 
In  dentifrices  borax  will  contribute  antacid  and  antiseptic  properties. 
This  drug  is  seldom  given  internally. 

Incompatibility.  Borax  in  saturated  aqueous  solution  is  decom- 
posed by  mineral  acids,  with  the  precipitation  of  boric  acid,  which  is 
less  soluble.  A  white  precipitate  is  also  thrown  down  by  corrosive  sub- 
limate. 

Liquor  Calcis.  Solution  of  Lime.  Lime-water.  A  saturated  aqueous 
solution  of  calcium  hydroxide  [Ca(OH)2].  It  is  readily  prepared  by  treat- 
ing freshly  slaked  lime  with  water.  It  is  strongly  alkaline  in  reaction, 
almost  tasteless,  and  very  agreeable  to  the  stomach.  It  may  be  used 
freely  as  a  mouth  wash  and  to  correct  undue  acidity  of  the  stomach. 
For  the  latter  purpose  it  is  very  commonly  added  to  the  food  of  infants, 
especially  in  the  digestive  disorders  occurring  during  the  summer, 
when  the  milk  so  easily  loses  its  normal  alkaline  quality. 

Incompatibility.  Carbon  dioxide  gas  produces  in  lime-water  a 
cloudiness,  due  to  calcium  carbonate.  Oxalic  acid  produces  a  white 
precipitate  of  calcium  oxalate.  With  corrosive  sublimate  a  yellowish 
precipitate  occurs,  and  with  calomel  a  black  deposit. 

Magnesii  Oxidum.  Light  Magnesia.  Magnesia  [MgO].  The 
light  magnesium  oxide  is  prepared  by  exposing  light  magnesium  car- 
bonate to  a  dull-red  heat.  It  is  a  white,  very  light  powder,  having  a 
slight  earthy  taste  and  alkaline  reaction.  It  is  insoluble  in  alcohol, 
almost  insoluble  in  water,  but  when  mixed  with  fifteen  parts  of  water 
and  allowed  to  stand  for  half  an  hour  it  gelatinizes,  forming  magnesium 
hydrate  or  "milk  of  magnesia."  This  drug  is  an  agreeable  antacid  for 
stomach  administration,  and  is  at  the  same  time  laxative.  This  com- 
bination of  properties  makes  it  a  useful  agent  for  the  treatment  of 
intestinal  disorders  of  childhood,  the  alkaline  quality  serving  to  neutralize 
any  undue  acidity,  and  the  laxative  action  ridding  the  bowel  of  offensive 
contents.     The  dose  is  5-60  grains  (0.30-4  gm.). 


MfERGENTS,  Antacids  And  alkalies  11*7 

Magnesia  should  be  kept  from  exposure  to  air,  as  it  slowly  absorbs 
moisture  and  carbon  dioxide,  forming  a  carbonate. 

In  the  form  of  the  hydrate,  or  milk  of  magnesia,  it  is  one  of  the  most 
useful  agents  to  neutralize  acids  in  the  mouth,  being  ranked  first  by 
some  practitioners.  This  preparation  is  easily  made  in  the  way 
mentioned  above  and  it  keeps  indefinitely.  Its  gelatinous  consistence 
causes  it  to  adhere  to  the  teeth  and  remain  about  them  for  a  con- 
siderable time,  which  is  a  decided  advantage.  It  may  be  used  freely 
in  any  mouth  and  at  any  age. 

Incompatibility.     Magnesia  is  neutralized  by  acids. 

Greta  Praeparata.  Prepared  Chalk  [CaCOg].  This  substance  is 
one  kind  of  calcium  carbonate.  It  occurs  in  form  of  a  whitish  powder, 
which  is  often  moulded  into  the  shape  of  small  cones.  It  is  nearly 
tasteless,  almost  insoluble  in  water,  insoluble  in  alcohol,  soluble  in 
acids  with  effervescence  and  chemical  change.  It  is  not  properly  an 
alkaline  substance,  but  an  antacid,  i.  e.,  it  neutralizes  acids,  but  does 
not  turn  red  litmus  blue.  Its  action  consists  of  a  chemical  union  with 
any  free  acid,  which  displaces  the  carbonic  acid  of  the  chalk.  It  may 
be  used  freely  internally,  as  an  antacid  in  gastric  and  intestinal  dis- 
orders. While  solubility  of  a  drug  is  usually  desirable  in  order  to  rapid 
action,  the  insolubility  of  prepared  chalk  gives  it  a  special  place  in 
dentistry.  Having  a  mild  scouring  quality,  and  being  antacid,  it  holds 
first  place  as  a  basis  for  tooth  powders.  Its  insolubility  also  gives  it  a 
prolonged  action  as  an  antacid,  so  that  in  a  mouth  with  a  marked  ten- 
dency to  acidity  it  may  be  packed  between  and  about  the  teeth  upon 
retiring,  and  its  action  will  continue  during  the  night.  This  use  is 
regarded  as  very  important  in  progressive  cases  of  erosion,  where  the 
damage  occurs  mostly  at  night,  when  there  is  less  saliva  secreted  and, 
accordingly,  the  secretions  of  the  mouth  do  not  become  so  well  mixed, 
the  mucus  remaining  upon  the  surfaces  of  the  teeth  and  about  the  gum 
margin.  The  extreme  sensitiveness  of  the  dentine,  which  is  present 
in  these  cases,  may  also  be  lessened  by  the  continuous  use  of  this  agent 
within  the  cavities  of  erosion  and  decay  and  about  the  teeth.  The 
accepted  belief  that  sensitiveness  of  dentine  is  often  due  to  irritation 
by  acids,  points  to  the  use  of  prepared  chalk  during  the  preparation  of 
any  cavity  where  sensitiveness  is  marked.  It  is  well  to  continue  its  use 
during  several  days  preceding  the  final  preparation  for  filling.  (See 
Index  of  Drugs  for  preparations  for  internal  use.) 

Incompatibility.  In  contact  with  acids  chalk  decomposes  with  effer- 
vescence, caused  by  the  liberation  of  carbon  dioxide. 


118  LOCAL  REMEDIES 


DILUENTS.     WATER.     MINERAL   WATERS. 

The  increasing  recognition  of  various  autointoxications  of  the  human 
system  as  the  most  disturbing  factors  in  many  diseases,  brings  into 
prominence  the  use  of  diluents,  especially  water,  in  the  aid  of  normal 
cell  function  through  free  elimination.  Particularly  after  full  develop- 
ment of  the  body,  in  other  words  after  the  play  period  of  life  has  passed, 
the  tendency  to  less  active  and  a  lessened  amount  of  exercise,  favors  a 
deficient  oxidation  of  food  substances  and  waste  tissue  materials,  with 
resulting  accumulations  of  partially  elaborated  products,  which  are 
more  or  less  deleterious.  A  distinct  group  of  diseases  related  to  such 
causes,  including  gout,  so-called  lithemia,  fermentative  digestive  dis- 
orders, chronic  rheumatism,  etc.,  give  evidence  of  the  extreme  impor- 
tance of  aiding  cell  elimination  throughout  the  body.  If  with  lessened 
exercise  the  usual  amount  of  food  is  still  taken,  the  conditions  are 
aggravated,  a  superabundance  of  nutriment  being  furnished  to  the 
tissues  whose  oxidation  processes  are  below  normal.  Moreover,  as  age 
advances,  with  development  completed,*  many  of  the  capillary  blood- 
vessels disappear  because  no  longer  needed.  The  capillary  circulation 
is  accordingly  less  active  and,  with  the  factors  of  excessive  food  material 
and  deficient  oxidation  co-operating,  the  tissues  easily  become  clogged, 
so  to  speak,  laying  the  foundation  for  the  diseases  mentioned.  The 
presence  of  arteriosclerosis  adds  another  contributing  factor  by  lessen- 
ing the  uniformity  of  blood  supply  to  the  capillaries.  The  relation  of 
these  conditions  to  oral  pathology  is  being  emphasized  today  in  classi- 
fication and  treatment  of  pericemental  and  alveolar  diseases. 

Uric  acid  is  recognized  as  a  product  of  partial  oxidation  of  nitrog- 
enous waste,  and  has  been  regarded  as  a  prominent  factor  in  gouty 
disorders.  At  the  present  time,  however,  doubt  is  being  thrown  upon  its 
importance  as  a  poison  to  the  system.  Nevertheless  it  stands  with  a 
group  of  substances  arising  in  the  body  through  faulty  cell  activity, 
some  of  which  are  acid  in  nature.  For  the  double  purpose  of  washing 
these  substances  out  of  the  tissues  into  channels  of  elimination  and  of 
diluting  them,  it  is  advisable  to  use  water  freely,  with  or  without  alkaline 
salts  for  antacid  effect.  Various  alkaline  mineral  waters  are  taken 
with  good  results,  and  the  salts  of  lithium  have  had  a  recent  extensive 
use;  but  many  physicians  now  give  preference  to  pure  water.     Dis- 

*  Balfour,  The  Senile  Heart,  MacMillan&  Co.,  1894,  p.  14. 


DETERGENTS,  ANTACIDS  AND  ALKALIES  119 

tilled  water,  because  of  its  greater  solvent  power,  being  devoid  of  salts, 
is  preferred  in  some  conditions.  In  whatever  kind,  the  taking  of  water 
in  the  quantity  of  one  or  two  quarts  daily  is  an  important  part  of  the 
constitutional  treatment  of  these  conditions.  Pure  water  is  a  diuretic 
and  the  addition  of  certain  salts  will  increase  this  action,  while  others 
will  induce  a  cathartic  action. 

While  the  natural  mineral  waters  are  useful  according  to  their  saline 
and  alkaline  constituents,  they  are  not  necessarily  superior  to  simple 
solutions  of  the  cathartic  and  diuretic  salts,  while  the  latter  permit  of 
modification  which  places  the  kind  and  degree  of  the  saline  action  under 
our  control.     (See  Cathartics  and  Diuretics.) 

Certain  artificial  combinations,  in  imitation  of  the  formulas  of  popular 
mineral  waters,  are  upon  the  market,  e.  g.,  artificial  Carlsbad  salts. 
These  seem  to  meet  a  demand,  but  their  employment,  as  well  as  that  of 
any  mineral  water,  should  be  based  upon  proper  discrimination  as  to 
indications  for  their  use. 


CHAPTEK  XI. 

ANTISEPTICS. 

The  term  antiseptic  in  a  general  sense  applies  to  the  antagonism 
of  sepsis — i.  e.,  to  whatever  measures  are  employed  to  prevent  the 
growth  and  propagation  of  disease-producing  bacteria,  also  to  counteract 
their  influence  and  to  remove  their  noxious  products.  If,  however,  we 
analyze  modern  antiseptic  treatment,  we  find  that  the  agents  and  means 
employed  vary  as  to  the  precise  part  they  play  in  bringing  about  the 
results.  One  agent  will  kill  the  bacteria;  it  is,  therefore,  a  germicide. 
Another  will  not  only  destroy  bacteria,  but  will  remove  the  noxious 
properties  of  putrefaction  and  fermentation;  this  is  a  true  disinfectant. 
Another  will  inhibit  the  growth  and  propagation  of  bacteria  without 
destroying  them  or  removing  their  noxious  products;  this  cannot  be 
designated  otherwise  than  as  a  simple  antiseptic — preventing  sepsis,  but 
not  removing  it  when  present.  A  deodorant  is  an  agent  that  removes  or 
corrects  an  offensive  odor. 

It  is  impossible,  however,  to  make  a  distinct  classification  in  accord- 
ance with  these  terms,  for  the  reason  that  many  agents  belong  to  one 
or  another  class,  according  to  the  strength  in  which  they  are  employed, 
being  in  strong  solution  germicidal  or  disinfectant,  and  in  weak  solution 
simply  antiseptic.  Other  conditions,  such  as  character  of  solvent, 
temperature  of  solution  and  character  of  bacteria,  also  modify  our 
designation  of  the  several  agents.  An  antiseptic  may  be  germicidal  to 
one  kind  of  bacterium  and  only  inhibitory  to  the  gro\\1;h  of  another. 
To  the  writer  it  seems  better  to  employ  the  term  antiseptic  in  its  general 
inclusive  sense,  to  cover  all  agents  employed  to  prevent,  counteract, 
and  remove  the  influence  of  disease  germs,  and  to  further  designate 
difl^erences  of  action  by  using  the  adjective  terms  germicidal  and  dis- 
injectant. 

The  intelligent  use  of  antiseptics  has  been  a  matter  of  development 
during  the  past  thirty  years,  following  closely  the  progress  made  in 
the  science  of  bacteriology.  AVhen  Pasteur  in  1857  proved  that  the 
processes  of  fermentation  and  putrefaction  were  caused  by  the  presence 
and  growth  of  organisms,  the  way  was  prepared  for  investigation  of 
(120) 


ANTISEPTICS  121 

septic  conditions  and  special  diseases.  In  1875  Lister  set  forth  the 
germ  theory  as  appKed  to  the  infection  of  wounds.  His  work  and 
methods  were  a  great  step  toward  reahzing  the  aseptic  surgical  methods 
of  today  and  are  referred  to  by  an  eminent  surgical  writer*  as  ha\ing 
"brought  about  an  entire  revolution  in  surgery  and  surgical  technique, 
and  an  entire  reversal  of  the  statistics  of  operations;  where  thousands 
formerly  died,  thousands  now  live,  their  lives  being  indirectly  due  to 
the  labors  of  this  one  man  and  his  following." 

Since  then  the  specific  organisms  of  many  diseases  have  been  dis- 
covered and  the  application  of  antiseptic  agents  has  become  more 
precise  and  the  results  more  definite. 

In  dental  practice  antiseptics  must  be  regarded  in  relation  to  widely 
differing  structures,  as  presented  by  the  teeth,  in  their  very  hard  mineral 
character,  by  the  softer  tissues  of  the  mouth,  and  by  the  extremely 
delicate  and  sensitive  tooth  pulp.  Indeed,  two  quite  distinct  fields 
are  before  the  dental  specialist  in  his  study  of  antiseptic  therapeutics. 
He  has  now  to  select  his  agents  for  mouth  disinfection  and  again  for  tooth 
disinfection.  For  mouth  treatment  his  antiseptics  must  be  selected  mth 
regard  to  safety  of  the  soft  tissues ;  for  tooth  disinfection  the  application 
is  of  such  limited  extent,  and  the  soft  structures  are  so  well  excluded, 
that  the  main  question  is  that  of  efficiency,  the  very  strongest  escharotics 
being  eligible  for  use;  then  also  treatment  of  the  tooth  pulp  will  require 
the  selection  of  agents  especially  adapted  to  its  condition.  These  con- 
siderations will  lead  to  the  use  of  the  terms  "mouth  disinfection"  and 
"tooth  disinfection"  in  the  discussion  of  antiseptics. 

The  ideal  condition  to  be  aimed  at  in  all  surgical  work  is  that  of 
asepsis,  or  absence  of  disease  germs.  The  operator  seeks  to  begin  his 
operation  with  perfect  asepsis.  To  this  end  his  instruments  are  sterilized 
by  boiling,  and  the  dressings  by  dry  heat  at  a  temperature  of  230°  or 
over,  while  his  hands  and  the  site  of  operation  are  treated  with  suitable 
disinfectants.  Asepsis  o'f  the  mouth  is  difficult  of  attainment,  but  the 
site  of  operation  may  usually  be  made  aseptic  after  exclusion  of  the 
fluids  by  a  sterile  rubber  dam,  and  the  condition  then  maintained 
through  the  use  of  sterile  instruments  by  sterile  hands. 

The  importance  of  thoroughly  sterilizing  all  instruments  that  have 
been  used  in  the  mouth,  after  each  dental  operation,  must  be  insisted 
upon.  There  can  be  no  doubt  that  one  must  frequently  operate  in  a 
syphilitic  mouth  without  being  aware  of  it,  because  the  lesions  may  be 

*  Park's  History  of  Medicine,  second  edition,  p.  261. 


122  LOCAL  REMEDIES 

slight  or  invisible.  In  secondary  syphilis  the  danger  of  carrying  the 
disease  to  another  mouth  or  of  infecting  a  chance  lesion  upon  the 
hand  is  very  great,  and  preventable  with  certainty  only  by  sterilization 
of  instruments  and  appliances.  Alcohol  has  been  regarded  as  a  disin- 
fectant for  this  .purpose,  but  its  value  is  questionable.  Absolute 
certainty  should  recjuire  sterilization  by  heat. 

Acidum  Boricum.  Boric  Acid.  Boracic  Acid  [H3BO3].  This  occurs 
in  transparent,  colorless  scales  or  crystals,  nearly  tasteless,  soluble  in 
18  parts  of  water,  15.3  parts  of  alcohol,  and  in  4.6  parts  of  glycerin. 
It  is  slightly  acid  in  reaction.  This  substance  is  found  in  various 
parts  of  the  globe  chiefly  in  the  form  of  natural  borates,  the  American 
market  being  supplied  from  the  borax  regions  of  California. 

The  saturated  aqueous  solution  of  this  drug  (5J  per  cent.)  is  largely 
used  as  an  antiseptic  wash.  It  is  non-irritating,  therefore  may  be  applied 
to  the  most  delicate  tissue.  As  an  eye  wash  it  is  much  used.  It  may 
be  employed  freely  as  a  mouth  wash,  the  only  objection  being  its  slight 
acidity.  However,  it  must  be  said  that  it  possesses  no  real  advantage 
over  its  sodium  salt.  In  powdered  form  it  is  used  in  tooth  powders  or 
dusted  upon  ulcers  or  w^ounds.  Attention  is  directed  to  the  formula 
of  an  antiseptic  solution  for  general  use,  into  which  boric  acid  enters 
prominently,  which  is  official  under  the  name  Liquor  Antisepticus. 

It  contains: 


Boric  acid, 

20.00  Gm. 

Benzoic  acid, 

1.00     " 

ThjTnol, 

1.00     " 

Eucalyptol, 

0.25  c.c. 

Oil  of  peppermint, 

0.50  " 

Oil  of  gaultheria, 

0.25  " 

Oil  of  thyme, 

0.10  " 

Alcohol, 

250.00  " 

Water,  to  make 

1000.00  " 

This  preparation  should  be  used  in  preference  to  the  many  proprietary 
liquids  of  uncertain  strength. 

Incompatibility.  In  aqueous  solution  boric  acid  is  decomposed  by 
carbonates,  with  the  formation  of  borates. 

Whenever  a  stronger  preparation  of  boric  acid  than  the  saturated 
solution  is  desired,  it  may  be  had  in  the  official  glyceritum  boroglycerini 
(glycerite  of  boroglycerin),  which  contains  31  per  cent,  of  boric  acid 
incorporated  by  chemical  union  with  glycerin.  This  may  be  used  in 
full  strength  or  diluted.    It  is  neutral  in  reaction. 


ANTISEPTICS  123 

Sodii  Boras.  Borax.  This  salt  has  been  discussed  under  Antacids. 
As  an  antiseptic  it  may  be  used  freely  in  saturated  solution  (5  per  cent.) 
as  a  mouth  wash,  or  the  crystal  may  be  allowed  to  dissolve  in  the  mouth. 
It  really  possesses  in  itself  every  essential  quality  of  a  mouth  antiseptic, 
though  of  the  weaker  class  of  agents.  It  is  alkaline,  non-irritating, 
almost  tasteless,  and  non-toxic.  Dobell's  solution*  is  a  very  useful 
combination. 

A  saturated  solution  in  glycerin  (equal  parts  of  each)  is  very  efficient 
in  the  removal  of  the  thrush  fungus  (oidium  albicans),  which  is  so  often 
seen  in  the  mouths  of  bottle-fed  infants.  The  thick  consistence  of  this 
solution  is  advantageous  in  that  it  thereby  adheres  to  the  mucous  mem- 
brane for  some  time.     It  should  be  applied  several  times  daily. 

Phenol.  Carbolic  Acid.  This  substance  has  been  considered  in  its 
action  upon  the  tissues,  under  Escharotics,  In  dilute  solutions  it  is 
one  of  the  most  generally  useful  antiseptics.  Although  slightly  acid  in 
reaction,  this  substance  is  not  an  acid,  chemically  speaking.  It  is  a 
coagulant  when  used  in  strong  solution,  and  while  this  property  may  be 
a  factor  in  its  antiseptic  action,  its  germicidal  power  may  be  thereby 
lessened  by  interference  with  penetration. 

Phenol  LicLuefactum,  Liquefied  Phenol,  containing  86.4  per  cent, 
by  weight  of  absolute  phenol,  is  convenient  for  ready  use  and  for  diluting. 

Phenol  is  soluble  in  about  20  parts  of  water,  giving  a  saturated  solution 
of  about  5  per  cent.  This  is  too  strong  for  use  upon  mucous. membranes, 
although  for  the  purpose  of  tooth  disinfection  the  pure  phenol  may  be 
used  with  due  care.  As  a  mouth-wash  or  gargle  it  has  the  advantage 
of  being  slightly  analgesic,  but  it  should  not  be  used  stronger  than  1  per 
cent.  The  slight  acidity  may  be  counteracted  by  combining  a  solution 
of  sodium  bicarbonate  with  it. 

Upon  the  skin  it  may  be  used  somewhat  stronger,  but  even  here  the 

*  The  formula  of  Dobell's  solution,  as  given  in  the  National  Formulary  under  the 
title  Liquor  Sodii  Boratis  Compositus  is: 

Gm.  or  c.c. 


B . — Sodii  boratis, 

15 

(3iv) 

Sodii  bicarbonatis, 

15 

(5iv) 

Phenolis  (crystals), 

3 

(gr.  xlv) 

Glycerini, 

35 

(fgj) 

Aquse, 

ad  q.  s. 

1000 

(Oij) 

Dissolve  the  salts  in  one-half  of  the  total  quantity  of  water,  then  add  the  glvcerin 
and  the  phenol,  previously  liquefied  by  warming,  and,  lastly,  enough  water  to  make 
up  the  total  quantity. 


124  LOCAL   REMEDIES 

continuous  application  of  a  solution  as  weak  as  1  to  5  per  cent,  has 
been  followed  by  gangrene,  the  result  probably  of  thrombosis.  This  is 
especially  liable  to  occur  in  a  finger  or  toe  where  all  vessels  of  supply 
are  equally  affected.  The  local  analgesic  action  undoubtedly  aids  in 
lowering  the  vitality  of  the  part  and  prevents  painful  sensation,  which 
otherwise  might  give  warning  of  the  danger.  A  whole  finger  has  been 
lost  in  this  way  as  a  result  of  the  application  of  carbolic  acid  solution. 

It  may  be  said  of  this  agent  that,  having  been  one  of  the  first  substances 
proposed  as  an  antiseptic  and  disinfectant,  it  has  held  its  place  for  more 
than  forty  years  as  one  of  the  best  drugs  of  the  class.  A  solution  of 
1  in  250  will  quickly  destroy  lower  forms  of  vegetable  life  and  check 
fermentation,  a  1  per  cent,  solution  may  be  relied  upon  as  a  general 
antiseptic,  while  a  5  per  cent,  solution  is  an  efficient  disinfectant. 

As  to  its  germicidal  power,  Harrington  found  that  a  5  per  cent, 
solution  destroyed  the  staphylococcus  pyogenes  aureus,  the  most  common 
and  most  resistant  pus  organism,  in  two  minutes;  a  2h  per  cent,  solution 
required  four  minutes.* 

In  saturated  solution  it  is  useful  to  keep  instruments  in  sterile  con- 
dition during  an  operation.  It  has  no  action  upon  metals;  therefore 
instruments  may  be  disinfected  by  its  use  in  full  strength,  bearing 
in  mind  always  that  any  albuminous  matter  will  be  coagulated  by  it 
instead  of  being  removed.  The  combination  known  as  liquor  sodii 
carbolatisf  contains  50  per  cent,  of  carbolic  acid. 

Internally  phenol  is  a  valuable  antiseptic.  In  doses  of  ^-2  minims 
(gm.  0.03-0.12),  well  diluted,  it  is  used  to  arrest  fermentation  in  the 
stomach  and  intestines,  an  advantage  of  its  use  being  that  it  does  not 
disturb  digestion. 

When  employing  this  drug,  it  must  always  be  borne  in  mind  that  it 
is  a  poison — corrosive  when  applied  in  full  strength  to  tissue;  and  also 
a  systemic  poison,  when  absorbed  in  quantity,  producing  irritation  of  the 

*  Annals  of  Surgery,  October,  1904. 

f  Liquor  sodii  carbolatis  (N.F.)  corresponds  very  closely  to  the  proprietary  prepara- 
tion known  as  phenol  sodique.    It  has  the  following  formula: 

Gm.  or  c.c. 

R. — Phenolis  (crystals),  50 

Sodii  hydroxidi,  3  5 

Aquae,  46  5 

Dissolve  the  soda  in  the  water,  add  the  phenol,  and  warm  gently  until  it  is 
dissolved. 

This  preparafion  should  be  freshly  made.  Used  in  full  strength  this  combination 
would  be  caustic. 


ANTISEPTICS  125 

kidneys  which  may  result  in  nephritis;  therefore,  caution  should  always 
attend  its  use,  and  in  view  of  the  frequency  of  poisoning  by  carbolic  acid 
every  practitioner  should  be  prepared  to  treat  the  same  in  emergency. 
Albumin  and  alcohol  are  the  antidotes,  and  for  systemic  treatment 
soluble  sulphates  are  employed.     (See  under  Escharotics.) 

Incompatibiliti/.  Phenol  will  coagulate  albumin  and  collodion.  In 
aqueous  solution  a  white  precipitate  occurs  with  hromine  water,  with 
ferric  chloride  a  violet  color  is  produced,  and  with  solution  of  antipyrin 
a  white  precipitate  occurs.  When  the  saturated  aqueous  solution  is 
mixed  with  a  solution  of  cocaine  hydrochloride  a  white  precipitate 
may  occur. 

Cresol.  Tricresol  [C^H^.OH].  A  mixture  of  three  isomeric  cresols 
obtained  from  coal-tar.  It  is  a  nearly  colorless  liquid,  becoming  yellowish 
or  brownish  upon  prolonged  exposure  to  Hght.  Its  odor  is  similar  to 
that  of  phenol.  It  is  soluble  in  60  parts  of  water  and  in  alcohol  and 
glycerin.  The  uses  of  this  substance  are  the  same  as  those  of  phenol. 
It  is  believed  to  be  a  more  powerful  disinfectant.  A  5  per  cent,  solution 
has  been  found  to  destroy  staphylococcus  pyogenes  aureus  in  two  minutes.* 

Trichlorphenol  [CgH^ClgOH]  (not  official).  The  action  of  chlorine 
upon  phenol  produces  a  series  of  bodies  whose  antiseptic  power  exceeds 
that  of  phenol.  Of  these  trichlorphenol  is  a  definite  crystalline  substance, 
soluble  in  alcohol  and  ether.  According  to  Nenckij  a  2  per  cent,  solution 
was  found  to  be  more  active  than  a  5  per  cent,  solution  of  phenol  and 
only  a  little  weaker  than  1  :  1000  solution  of  bichloride  of  mercury. 

Creosotum.  Creosote.  Oil  of  Smoke.  A  mixture  of  phenols  obtained 
by  distillation  of  wood-tar.  (For  preparations  and  doses,  see  Index  of 
Drugs.)  In  addition  to  the  discussion  of  this  substance  in  the  class  of 
irritants,  its  use  as  an  antiseptic  claims  consideration  at  this  place. 
Obtained  usually  from  beech  wood-tar  by  distillation,  creosote  is  always 
liquid,  nearly  colorless  when  •  fresh,  but  becoming  yelloT\ash.  The 
U.  S.  P.  states  that  it  should  not  become  brown  on  exposure  to  light.  It 
is  neutral  or  only  faintly  acid  to  litmus  paper.  It  is  soluble  in  about  140 
parts  of  water,  and  more  freely  in  absolute  alcohol,  ether,  chloroform 
and  oils.  In  some  respects  it  resembles  liquefied  phenol,  but  the  latter 
acquires  a  pink  or  reddish  color  mth  exposure;  in  odor  it  is  somewhat 
similar,  although  decidedly  smoky  and  unpleasant.  It  is  less  useful 
in  dental  practice,  because  of  its  odor  and  also  the  fact  that  it  discolors 

*  Harrington,  Annals  of  Surgery,  October,  1904. 
t  U.  S.  Dispensatory,  eighteenth  edition,  p.  1615. 


126  LOCAL  REMEDIES 

teeth  by  continuous  treatment.    The  chief  points  of  difference  between 
the  two  substances  are  given  below: 

Phenol.  Creosote. 

Crystallizable.  Always  liquid. 

A  definite  chemical  compound.  A  mixture  of  phenols. 

Coagulates  collodion.  Does  not  coagulate  collodion. 

Soluble  in  glycerin.  Insoluble  in  glycerin. 

Soluble  in  about  20  parts  of  water.  Soluble  in  about  140  parts  of  water. 

In  antiseptic  power  creosote  surpasses  phenol,t  and  its  internal  use 
is  safer.  In  recent  years  it  has  been  used  extensively  as  an  internal 
remedy  in  the  treatment  of  pulmonary  tuberculosis,  tolerance  to  quite 
large  doses  being  readily  acquired.  It  has  a  local  analgesic  and  sedative 
effect,  which  makes  it  a  valuable  inhalant. 

In  full  strength  creosote  is  an  excellent  tooth  disinfectant,  being 
preferred  to  carbolic  acid  by  some,  because  it  has  little  or  no  coagulant 
action.*  It  penetrates  more  deeply,  but  is  less  corrosive.  As  it  is  apt  to 
discolor  tooth  structure  it  is  not  to  be  used  in  teeth  that  are  visible. 

As  a  mouth  wash  it  may  be  used  freely  in  saturated  aqueous  solution 
(f  per  cent.),  but  its  unpleasant  odor  and  taste  are  objectionable.  The 
official  aqua  creosoti  is  prepared  with  1  per  cent,  of  creosote,  in  order 
to  insure  saturation. 

On  the  whole,  it  may  be  said  that  in  dental  practice  creosote  is  used 
little  compared  with  phenol,  though  a  stronger  antiseptic. 

Poisoning  by  this  drug  would  occur  by  swallowing  a  quantity  of  it 
pure.  The  symptoms  would  be  those  of  irritant  poisoning.  It  has  no 
definite  chemical  antidote.  Emetics  would  be  indicated,  followed  by 
demulcents. 

Guaiacol  [QH^jOJ.  A  crystalline  solid  obtained  from  creosote  and 
constituting  from  60  to  90  per  cent,  of  the  latter.  It  is  soluble  in  53 
parts  of  water,  1  part  of  glycerin  and  also  soluble  in  alcohol  and  ether. 
Being  a  more  definite  substance,  it  forms  a  number  of  combinations, 
some  of  which,  as  well  as  itself,  are  used  as  substitutes  for  creosote  for 
internal  administration.  Guaiacol  has  been  used  as  a  vehicle  for  cocaine 
in  its  application  by  cataphoresis. 

*  It  is  stated  by  some  authorities  that  creosote  contains  some  carbolic  acid  and  that 
it  coagulates  albumin.  This  was  formerly  true,  when  pure  creosote  was  difficult  to 
obtain  and  adulteration  with  carbolic  acid  was  common;  but  at  the  present  time 
pure  creosote  is  easily  obtainable  and  it  has  little  coagulant  action.  However, 
creosote  being  a  mixture  of  substances,  its  properties  may  vary  slightly, 
•j-  See  table  on  p.  132. 


ANTISEPTICS  127 

Guaiacolis  Carbonas.  Guaiacol  Carbonate  [(C^H-OjgCOg].  A  white 
crystalline  powder,  insoluble  in  water,  soluble  in  48  parts  of  alcohol, 
neutral  and  almost  tasteless. 

Alcohol.  This  drug,  fully  considered  in  other  places  as  astringent  and 
stimulant,  has  some  reputation  as  an  antiseptic.  Its  action  upon  bacteria 
is  probably  due  to  its  power  of  abstracting  water  and  of  coagulating 
albumin.  It  is  less  valuable  as  a  disinfectant  than  as  a  simple  antisep- 
tic and  as  a  vehicle  for  stronger  agents  of  this  class.  It  must  be  used 
in  strength  of  40  per  cent,  or  more  to  have  any  decided  antiseptic 
value ;  however,  upon  the  dry  skin  the  very  strong  alcohol  (absolute  and 
95  per  cent.)  has  been  found  less  efficient  than  if  it  is  diluted  somewhat. 
This  is  due  to  the  hardening  effect  of  the  undiluted  alcohol  which  hinders 
penetration. 

The  experiments  of  Harrington  and  Harris*  as  to  the  germicidal  power 
of  alcohol  in  different  strengths  led  to  the  following  results: 

"  1.  Against  dry  bacteria,  absolute  alcohol  and  ordinary  commercial 
alcohol  are  wholly  devoid  of  bactericidal  power,  even  with  twenty-four 
hours'  direct  contact ;  and  other  preparations  of  alcohol  containing  more 
than  70  per  cent.,  by  volume,  are  weak  in  this  regard,  according  to  their 
content  of  alcohol;  the  stronger  in  alcohol,  the  weaker  in  action. 

"  2.  Against  the  commoner,  non-sporing,  pathogenic  bacteria  in  a 
moist  condition,  any  strength  of  alcohol  above  40  per  cent.,  by  volume, 
is  effective  within  five  minutes,  and  certain  preparations  within  one 
minute. 

"  3.  Alcohol  of  less  than  40  per  cent,  strength  is  too  slow  in  action  or 
too  uncertain  in  results  against  pathogenic  bacteria,  whether  moist  or 
dry. 

"  4.  The  most  effective  dilutions  of  alcohol  against  the  strongly  resist- 
ing (non-sporing)  bacteria,  such  as  the  pus  organisms,  in  the  dry  state, 
are  those  containing  from  60  per  cent,  to  70  per  cent,  by  volume,  which 
strengths  are  equally  efficient  against  the  same  organisms  in  the  moist 
condition. 

"  5.  Unless  the  bacterial  envelope  contains  a  certain  amount  of  mois- 
ture, it  is  impervious  to  strong  alcohol ;  but  dried  bacteria,  when  brought 
into  contact  with  dilute  alcohol  containing  from  30  per  cent,  to  60  per 
cent,  of  water  by  volume,  will  absorb  the  necessary  amount  of  water 
therefrom  very  quickly,  and  then  the  alcohol  itself  can  reach  the  cell- 
protoplasm  and  destroy  it. 

*  Boston  Medical  and  Surgical  Journal,  May  21,  1903. 


128  LOCAL  REMEDIES 

"  6.  The  stronger  preparations  of  alcohol  possess  no  advantage  over 
the  60  per  cent,  to  70  per  cent,  preparations,  even  when  the  bacteria  are 
moist;  therefore,  and  since  they  are  inert  against  dry  bacteria,  they 
should  not  be  employed  at  all  as  a  means  of  securing  an  aseptic  condition 
of  the  skin." 

Certain  of  the  vegetable  tinctures  have  a  reputation  as  antiseptics, 
which  with  a  few  is  well  founded.  When  we  consider  the  value  of  the 
contained  alcohol,  it  appears  that  any  addition  of  a  drug  that  has  anti- 
septic power  should  produce  a  valuable  preparation. 

Tinctura  Mjnrhse.  Tincture  of  Myrrh  has  long  been  used  as  a  local 
application  to  the  gums,  and  as  an  ingredient  in  mouth  washes.  To 
irritated,  lacerated  or  spongy  gums,  ulcers,  etc.,  it  may  be  applied  freely. 
It  cannot  be  diluted  with  water,  for  the  latter  precipitates  the  resinous 
portion  of  myrrh.  It  can  only  be  mixed  ^vith  water  or  aqueous  solutions 
in  the  presence  of  a  large  percentage  of  alcohol.  A  dilution  of  alcohol 
with  more  than  one-third  water  will  not  mix  with  tincture  of  myrrh 
without  precipitation  occurring. 

Tinctura  Benzoini.    Tincture  of  Benzoin  (20  per  cent.). 

Tinctura  Benzoini  Composita/''  Compound  Tincture  of  Benzoin 
(10  per  cent,  benzoin). 

Benzoin  contains  resin,  benzoic  acid  (about  14  per  cent.)  and  traces 
of  a  volatile  oil.  Benzoic  acid  has  been  found,  by  a  number  of  ob- 
servers, to  rank  among  our  very  best  non-irritating  antiseptics,  and  it 
is  freely  soluble  in  alcohol;  therefore,  these  tinctures  should  be  valuable 
antiseptics,  as  they  contain  2  to  3  per  cent,  of  benzoic  and  cinnamic 
acids,  the  latter  being  also  valuable. 

The  compound  tincture  is  a  time-honored  preparation,  and  one  of 
the  best  antiseptic  and  stimulant  applications  to  mucous  membranes. 
An  unhealthy  or  ulcerated  condition  of  the  gums  calls  for  its  use.  It 
must  be  applied  upon  cotton.  It  cannot  be  used  in  a  mouth  wash 
because  of  the  precipitation  of  the  resin  when  mixed  with  water.  Except 
the  resinous  portion,  it  may  be  vaporized  with  steam  by  being  poured 
upon  boiling  water,  and  it  thus  forms  a  useful  inhalant  in  irritable  or 


*  The  formula  of  compound  tincture  of  benzoin  contains: 

Benzoin,  100  parts. 

Purified  aloes,  20     " 

Storax,  80      " 

Balsam  of  tolu,  40      " 

Alcohol,  to  make  1000     " 


ANTISEPTICS  129 

infected  conditions  of  the^  upper  air  passages.     A  useful  prescription 
for  this  purpose  is  the  following: 

Gm.  or  c.c. 

H . — Phenolis  liquefacti,  8  (foij) 

Tincturpe  benzoini  compositse,       24  (f3vj) 

Glycerini,  q.  s.  ad         60  (foij) — ^I- 

Sig. — A  teaspoonful  to  a  pint  of  boiling  water.    Inhale  the  steam. 

For  the  correction  of  foul  breath,  when  due  to  an  unhealthy  con- 
dition of  tonsils  or  upper  air  passages,  the  same  inhalation  is  useful; 
in  addition  the  compound  tincture  may  be  applied  in  full  strength 
to  the  surface  of  the  tonsil  and  within  all  of  its  crypts  that  are  visible. 
Foul  breath  may  be  due  to  the  collection  of  solid  offensive  secretion 
within  these  crypts.  This  should  be  removed  before  making  the 
application. 

Acidum  Benzoicum.  Benzoic  Acid  [HC^HjOJ.  An  organic  acid 
obtained  from  benzoin,  or  prepared  artificially.  This  drug  occurs 
in  whitish  crystals,  with  or  without  the  odor  of  benzoin,*  soluble  in 
281  parts  of  water,  but  with  an  equal  quantity  of  borax  it  is  soluble  in 
100  parts  of  water;  soluble  also  in  1.8  parts  of  alcohol  and  in  10  parts 
of  glycerin.  It  has  an  acid  reaction.  A  solution  of  1  :  400  has  been 
found  to  destroy  developed  bacteria;  and,  according  to  Miller,  a  1  per 
cent,  solution  will  accomplish  ordinary  disinfection  of  the  mouth  in 
one-quarter  of  a  minute. f  With  its  solubility  in  water  increased  by 
borax,  the  two  may  be  combined  in  aqueous  solution  to  make  a  very 
efficient  mouth  wash.  It  is  found  that  a  saturated  solution  of  borax  will 
dissolve  1  per  cent,  or  more  of  benzoic  acid  and  still  be  alkaline. 

Incompatibility.  ^Mien  a  solution  of  benzoic  acid  has  been  neutralized 
by  an  alkali,  as  ^ath  borax,  a  precipitate  will  occur  when  mixed  with 
Jiydrochloric  or  dilute  nitric  acid,  or  with  dilute  solutions  of  Jerric  salts, 
or  with  lead  acetate,  mercuric  chloride  or  silver  nitrate. 

Acid,  Cinnamic  [HCglljOJ  (not  official).  A  colorless,  crystalline 
substance  occurring  in  balsams  and  in  old  oil  of  cinnamon.  It  is  C|uite 
similar  to  benzoic  acid,  into  which  substance  it  is  convertible  by  oxida- 
tion. It  is  slightly  soluble  in  water  and  readily  soluble  in  alcohol.  Its 
uses  are  the  same  as  those  of  benzoic  acid. 

Acidum  Salicylicum.  Salicylic  i^ciD  [HC^HjOg].  An  organic  acid 
obtained  from  vegetable  sources  or  prepared  from  carbolic  acid.  Occurs 
in  very  fine,  white  needles  or  crystalline  powder,  having  a  sweetish  taste. 

*  Benzoic  acid  prepared  artificially  does  not  have  the  odor  of  benzoin, 
t  The  same  applies  to  salicylic  acid  (see  p.  128). 

9 


130  LOCAL   REMEDIES 

It  is  soluble  in  308  parts  of  water  and  in  2  parts  of  alcohol,  2  parts  of 
ether,  80  parts  of  chloroform,  2  parts  of  olive  oil,  and  in  60  parts  of 
glycerin.  It  is  acid  in  reaction.  According  to  Miller,*  a  1  per  cent. 
solution  will  accomplish  ordinary  disinfection  of  the  mouth  in  one- 
quarter  of  a  minute.  It  must  be  ranked  among  our  best  antiseptics, 
but  it  is  objectionable  for  continued  use  because  of  its  acid  reaction. 
The  saturated  aqtieous  solution  is  rather  weak  to  be  of  much  value  as 
a  disinfectant;  but  a  saturated  solution  of  borax  in  water  will  dissolve 
1  per  cent,  or  more  of  salicylic  acid  and  still  be  alkaline  in  reaction. 
Such  a  solution  really  makes  an  ideal  mouth  wash.  The  drug  may  also 
be  used  as  a  mouth  wash  either  in  combination  with  other  antiseptics 
or  in  alcoholic  solution  diluted. 

Incoiiipatibility.  "With  potassium  chlorate,  hydrochloric  acid,  nitric 
acid,  chlorine  or  a  solution  of  ferric  chloride,  it  undergoes  chemical 
change.  It  causes  gradual  decolorization  of  a  solution  of  potassium 
permanganate.  With  carbonates  it  effen'esces,  vidth  the  formation  of 
salicylates. 

Sodii  Salicylas.  Salicylate  of  Sodiu:^!  [NaC^HgOg].  This  salt  is 
much  more  soluble  in  water  than  is  the  acid,  being  soluble  in  0.8  part, 
also  in  5.5  parts  of  alcohol,  and  in  glycerin.  For  internal  use  it  is  less 
disturbing  to  the  stomach  than  salicylic  acid,  and  it  is  used  largely  in 
the  acute  stage  of  rheumatism  to  control  the  fever  and  pain.  It  is  not 
a  very  efficient  antiseptic.     Internal  dose,  gr.  5-30  (gm.  0.30-2), 

Phenylis  Salicylas.  Salol  [C^gH^gOo].  Occurs  in  form  of  a  white, 
crystalline  powder,  having  a  sweetish  taste,  almost  insoluble  in  water, 
soluble  in  5  parts  of  alcohol,  and  in  ether,  chloroform  and  oils.  It  melts 
at  42°  C.  (107.6°  F.).  Its  use  in  dentistrj^  depends  upon  the  ease  T^dth 
which  it  can  be  fused,  and  the  fact  that,  when  fused  at  a  temperature  con- 
siderably above  its  melting  point,  recrystallization  is  retarded.  ^Mascortf 
in  1894  advocated  its  use  in  melted  form  as  a  root-canal  filling.  Being 
a  feeble  antiseptic  unless  decomposed,  its  ready  adaptability  and  non- 
irritating  character  must  be  its  chief  recommendations.  It  is  used  either 
alone  or  in  connection  with  a  cone  of  gutta-percha.  This  substance  is 
not  often  employed  as  a  local  antiseptic,  because  of  its  insolubility  in 
water.  It  may,  however,  be  used  in  alcoholic  solution.  Its  chief  use 
is  as  an  intestinal  antiseptic.  Its  adaptability  to  this  use  lies  in  the  fact 
that,  passing  tlirough  the  stomach  unchanged,  it  is  first  decomposed 
into  carbolic  and  salicylic  acids  by  contact  with  the  alkaline  juices  in 

*  Micro-organisms  of  the  Human  !Mouth.  f  Dental  Cosmos,  1894,  p.  352. 


ANTISEPTICS  131 

the  small  intestine,  where  the  effect  of  these  two  antiseptic  substances 
is  then  obtained.  It  is  valuable  in  diarrheas  and  intestinal  fermentation, 
but  with  large  doses  toxic  effects  of  phenol  are  possible.  Internal  dose, 
gr.  1-10  (gm.  0.06-0.60). 

VOLATILE  OIL  GROUP. 

Volatile  oils  are  odorous,  volatile  principles,  not  possessing  the  chemical 
qualities  of  true  oils.  They  are  colorless  or  nearly  so  when  freshly  dis- 
tilled, becoming  somewhat  colored  with  age  and  exposure,  without  losing 
any  of  their  valuable  properties.  They  are  insoluble  in  water,  soluble 
in  alcohol,  ether,  chloroform  and  fixed  oils.  The  volatile  oils  as  a  class 
are  antiseptics.  Some  have  an  analgesic  effect  when  applied  to  sensitive 
tissue,  while  others  are  irritating  and  a  few  are  poisonous.  Some  are 
not  applicable  to  uses  about  the  mouth  because  of  unpleasant  taste  or 
odor.  Most  of  them  are  used  in  full  strength  as  disinfectants  in  root 
canals  and  in  carious  cavities,  but  by  prolonged  use  they  may  discolor 
the  tooth  structure. 

■  Even  with  pulp  exposure  the  non-irritating  oils  may  be  used.  They 
do  not  destroy  tissue,  they  do  not  coagulate  albumin,  hence  they  penetrate 
well,  and  any  irritation  from  brief  application  is  but  slight  and  moment- 
ary. Exception  to  the  last  statement  is  found  with  oils  of  turpentine 
and  mustard,  but  these  are  seldom  used  in  the  mouth  because  of  their 
rank  odor. 

Dr.  A.  H.  Peck*  has  contributed  some  excellent  experimental  work 
with  the  volatile  oils  and  a  few  other  antiseptics,  in  which  he  studied 
their  antiseptic  power,  their  action  upon  soft  tissues,  their  influence  upon 
the  healing  of  sores  and  their  germicidal  action  upon  infected  sores. 
He  very  properly  holds  that  the  volatile  oils  and  other  agents  have  been 
used  "without  reference  to  their  relative  merits  as  antiseptics,  or  to 
their  therapeutic  effects  upon  the  tissues  to  which  they  are  applied." 

From  these  observations,  a  summary  of  which  is  given  in  the  table 
following,  he  concludes  that  the  oils  of  cinnamon  (including  oil  of  cassia), 
while  high  in  antiseptic  value,  are  too  irritating  to  be  used  in  root  canals. 
Also  that  oil  of  cloves  and  creosote  are  superior  agents,  both  being  effi- 
cient antiseptics,  while  non-irritating  to  soft  tissues.  In  fact,  he  found 
oil  of  cloves  to  possess  local  analgesic  properties  to  a  marked  degree.  He 
regards  oil  of  gaultheria  as  useless.  Formalin  he  discards  in  the  treat- 
ment of  conditions  about  the  mouth. 

*  The  Dental  Review,  August,  1898,  p.  593. 


132 


LOCAL  REMEDIES 


Attention  is  asked  to  the  comparative  table  below,  following  which  the 
several  volatile  oils  are  described  separately: 

Antiseptic  Power  and  Local  Action  of  Certain  Volatile  Oils  and  Other 
Substances  (Dr.  A.  H.  Peck).* 

Antiseptic  Power.  Action  on  Soft  Tissues. 
10  c.c.  of  sterile  mutton  bouil- 
lon as  culture  medium.    Growth  When     confined     to         When         sprayed 
of  mouth  bacteria  prevented  by  skin  by  rubber  cap.          upon    artificial    sore 
amounts  given  below  in  drops.  (guinea- jMg) . 
(Ratio  varies  as  size  of  drop.)  Ratio. 

Oil  of  cassia 0.3  drop,   or  1:2233     24  hrs.      Blister;    in-     Healing  prevented. 

tense  inflammation 
Oil  of  cinnamon  with  slow  healing. 

(Ceylon) 0.3     "  1:2100     24  hrs.      Blister;  less     Healing  prevented. 

Oil  of  cinnamon  severe  than  above. 

(synthetic) 0.3     "  1:2133     15  hrs.     Blister;  but 

Creosote  (beech-  no  inflammation. 

wood) 0.5     "  1:1280     36  hrs.    No  irritation.     Sore  healed. 

Oil  of  cloves 0.6     "  1:1150     36  hrs.    No  irritation.     Rapid  healing. 

Oil  of  bay. 0.7     "  1: 1028     36  hrs.    No  irritation.     Inflammation  sub- 

sided gradually. 
Oil  of  sassafras. ..  .0.7     "  1:1000     36  hrs.    No  irritation.     Inflammation  sub- 

sided. 
Oil  of  peppermint. .  0. 8     "  1:875       36  hrs.    No  irritation.     Inflammation  sub- 

sided. 
Black's  "  1-2-3  "t- .  1-4  drops,  or  1:  454       36  hrs.    No  irritation.     Inflammation  sub- 
sided. 

Phenol  (95%) 1.8      "  l:338t 

Oil  of  cajuput 6         "  1:120       36  hrs.    No  irritation.     No  irritation. 

Eucalyptol  (San- 
der's and  Merck's)  6         "  1:116       36  hrs.    No  irritation.     Inflammation  sub- 
Eucalyptol  sided. 

(ordinary) Saturated    solution 

required. 
Oil  of  gaultheria.  .  .  No  action  even  in 
saturated  solution 
(8  drops). 

Formalin 0.4  drop,   or  1 :  1400       4  hrs.    Severe  pain. 

20  hrs.     Severe  inflammation,  followed  by 
sloughing  and  toxic  symptoms. 

Germicidal  Action.  Applied  to  infected  sores,  pus  germs  were  destroyed  by 
the  cinnamon  oils,  creosote,  oil  of  cloves,  oil  of  bay,  oil  of  peppermint  and  Black's 
"  1-2-3."  Oil  of  sassafras  was  less  efficient,  while  the  action  of  oil  of  cajuput  and 
eucalyptol  was  not  very  positive. 

•    Oleum  Cinnamomi.     Oil  of  Cinnamon.     Oil  of  Cassia.     A  volatile 

oil  distilled  from  Cassia  cinnamon  (bark  and  leaves),  containing  not 

less  than  75  per  cent,  of  cinnamic  aldehyde,  upon  which  its  value  depends. 

It  is  yellowish  or  brownish  in  color,  becoming  darker  and  thicker  by  age 

and  exposure;  sp.  gt.  about  1.055;  soluble  in  2  parts  of  70  per  cent,  alcohol. 

The  changes  by  age  are  due  to  the  oxidation  of  cinnamic  aldehyde  to 

*  For  article  forming  basis  of  this  summary,  see  Dental  Review,  Aug.,  1898. 
t  Black's  "  1-2-3  "  mixture  (mild)  consists  of  1  part  oil  of  cassia,  2  parts  phenol 
(crystals),  and  3  parts  oil  of  gaultheria. 

J  The  influence  of  phenol  was  transient,  growth  occurring  after  three  days. 


ANTISEPTICS  133 

cinnamic  acid  and  resins;  therefore,  the  oil  should  be  kept  from  expo- 
sure to  light  and  air  in  well-stoppered,  amber-colored  bottles,  in  a  cool 

^  place. 

Oil  of  cinnamon  is  non-coagulant  to  tissues,  it  is  penetrating,  it  is  agree- 
able in  odor  and  the  discomfort  of  its  application  to  soft  tissues  is  mo- 
mentary, unless  it  is  confined  for  some  time,  when  it  may  cause  severe 
irritation.  It  is  doubtless  the  most  powerful  antiseptic  of  all  the  volatile 
oils  used  in  dentistry  (see  preceding  table).  It  is  used  for  tooth  disin- 
fection, but  is  less  applicable  to  front  teeth  than  to  posterior  ones,  because 
of  its  discoloring  effect  with  continued  use,  this  being  due  to  its  tendency 
to  become  darker  with  exposure. 

It  may  be  used  in  full  strength  in  pyorrhea  with  deep  pockets.  The 
official  cinnamon  water  is  useful  as  a  mouth-wash  and  to  irrigate  fistulous 
tracts,  as,  according  to  Dr.  Peck's  report,  it  should  be  able  to  prevent 
the  growth  of  mouth  bacteria.*  It  is  very  pleasant  to  the  taste  and  can 
well  be  used  in  preference  to  proprietary  liquids  of  complex  composi- 
tion and  uncertain  value. 

Cinnaldehydum.  Cinnamic  Aldehyde  [CgHgO].  An  aldehyde  ob- 
tained from  oil  of  cinnamon  or  prepared  synthetically.  It  should  be 
95  per  cent,  in  strength.  It  is  nearly  identical  with  the  official  oil  of 
cinnamon,  having  the  same  qualities  in  general,  but  being  more  definite 
in  composition.     At  a  low  temperature  it  becomes  solid,  melting  again 

■'  at  18.5°  F.     It  is  sparingly  soluble  in  water,  but  soluble  in  alcohol,  ether 
and  oils.     Its  uses  are  the  same  as  those  of  oil  of  cinnamon. 

/     Oleum  Caryophylli.     Oil  of   Cloves.     A  volatile  oil  obtained  from 

w  cloves  by  distillation,  varying  in  color  from  pale  yellow  to  brown,  age 

and  exposure  producing  the  change.     It  has  the  odor  and  taste  of  cloves, 

is  soluble  in  1  part  of  alcohol,  the  resulting  solution  having  a  slightly 

acid  reaction.     Sp.  gr.  about  1.050.     Its  chief  constituent   of  value  is 

•'eugenol,  of  which  it  should  contain  80  per  cent. 

While  the  change  in  color  probably  does  not  impair  its  value,  it  should 
be  kept  well  protected  from  light  and  air,  so  as  to  retard  its  tendency  to 
change. 

Oil  of  cloves  has  a  high  antiseptic  value  (1:  1150  for  mouth  bacteria), 
while  Dr.  Peck's  experiments  have  proved  positively  that  it  is  not  only 
non-irritating  locally,  but  that,  when  applied  to  inflamed  or  infected  tis- 
sues, it  is  decidedly  soothing,  and  healing  progresses  rapidly  under  its 
application.     With  other  volatile  oils  it  is  non-coagulant  to  tissue. 

*  The  IJ.  S.  P.  formula  for  aq.  cinnamomi  uses  2  parts  of  oil  to  1000  of  water. 
It  is  estimated  that  one-half  of  the  oil  is  dissolved. 


134  LOCAL  REMEDIES 

It  can  be  used  freely  as  a  tooth  and  root  canal  disinfectant,  though  its 
tendency  to  discolor  prohibits  its  use  in  front  teeth.  It  is  undoubtedly 
entitled  to  a  larger  place  as  an  application  to  irritated  and  infected 
tissues. 

In  addition  to  its  dental  uses,  oil  of  cloves  is  employed  in  the  preparo,- 
tion  of  microscopic  specimens. 

Eugenol.  [C10H12O2].  An  aromatic  phenol,  the  chief  constituent  of  oil 
of  cloves,  but  obtainable  also  from  other  sources.  Sp.  gr.  about  1.073. 
It  is  similar  to  oil  of  cloves  in  all  of  its  qualities  and  is  applicable  to  the 
same  uses.  It  may  be  mixed  with  alcohol  in  any  proportion  and  it  is 
soluble  in  2  parts  of  70  per  cent,  alcohol. 

The  two  following  agents  are  very  similar,  both  owing  their  value 
chiefly  to  cineol  (identical  with  cajuputol  and  eucalyptol). 

Oleum  Cajuputi.  Oil  op  Cajuput.  A  volatile  oil  obtained  from  the 
fresh  leaves  and  twigs  of  Melaleuca  leucadendron.  Its  chief  constituent 
is  cineol,  of  which  there  should  be  at  least  55  per  cent. 

It  is  a  light,  thin,  colorless  or  bluish-greeji  liquid,  with  an  aromatic 
odor  and  taste.  It  is  soluble  in  1  part  of  alcohol,  the  solution  being 
neutral.     Sp.  gr.  about  0.920. 

Oleum  Eucalypti.  Oil  of  Eucalyptus.  Distilled  from  the  fresh 
leaves  of  Eucalyptus  globulus,  this  volatile  oil  owes  its  value  to  cineol 
(eucalyptol),  of  which  it  should  contain  50  per  cent.  It  is  soluble  in 
alcohol,  the  solution  being  neutral.     Sp.  gr.  about  0.915. 

It  is  similar  to  oil  of  cajuput  because  of  the  presence  of  cineol  in  nearly 
the  same  proportion.  It  has  no  distinct  value  in  comparison  with  other 
volatile  oils,  and  preference  is  usually  given  to  the  following  chief  con- 
stituent, which  is  more  definite  than  the  oil. 

Eucalyptol.  Cineol.  Cajuputol  [CjoHigO].  An  organic  oxide 
obtained  from  oil  of  eucalyptus  and  other  sources.  It  is  a  colorless 
liquid  with  an  aromatic,  camphoraceous  odor  and  a  spicy,  cooling  taste. 
It  is  soluble  in  alcohol  in  any  proportion,  the  solution  being  neutral. 
Sp.  gr.  0.925.  When  cooled  to  somewhat  below  the  freezing-point  it 
becomes  crystalline,  melting  again  at  30.2°  F.  It  should  be  kept  pro- 
tected from  air  and  light. 

Eucalyptol  has  no  special  advantage  over  the  stronger  volatile  oils, 
though  regarded  by  some  as  especially  detergent  in  root  canals.  It  is 
non-irritating  and  non-coagulant.  Its  antiseptic  value  is  shown  in  the 
table  on  p.  132. 


ANTISEPTICS  135 

Oleum  Thymi.     Oil  of  Thyme,     A  volatile  oil  distilled  from  leaves 
and  flowering  tops  of  Thymus  vulgaris.     It  is  colorless,  having  a  strong 
odor  of  thyme,  soluble  in  one-half  its  volume  of  alcohol,  the  solution 
'  being  neutral  or  very  slightly  acid.     It  contains 

Thymol,  a  phenol  [CiqH^^O],  which  occurs  in  large,  colorless  crystals, 
having  a  penetrating  odor  of  thyme  and  an  aromatic  taste,  soluble  in 
1100  parts  of  water,  very  soluble  in  alcohol,  also  soluble  in  oils.  It  is 
used  as  an  antiseptic.  An  official  combination  is  the  following: 
''  Thymolis  lodidum,  Thymol  Iodide  [C20II24O2I2].  This  substance, 
known  also  as  Aristol,  contains  45  per  cent,  of  iodine.  It  is  a  reddish- 
yellow  or  brownish  powder,  insoluble  in  water  and  glycerin,  very  slightly 
soluble  in  alcohol,  freely  soluble  in  ether  and  in  oils.  It  does  not  keep 
well  unless  protected  from  light.  It  is  used  as  an  antiseptic  powder, 
and  is  applicable  as  a  pulp-canal  dressing. 

Oleum  Menthge  Piperitae.  Oil  of  Peppermint.  A  volatile  oil  dis- 
tilled from  the  leaves  and  flowering  tops  of  peppermint.  It  is  colorless, 
neutral  and  soluble  in  an  equal  volume  of  alcohol.  It  should  be  kept 
in  a  cool  place  and  protected  from  light.  It  possesses  a  strong  odor  of 
^  peppermint.  Its  contact  with  tissue  is  followed  by  a  sensation  of  cold. 
In  form  of  the  spirit  (10  per  cent.)  it  is  given  internally  as  a  carminative. 
Locally  it  is  analgesic  and  antiseptic,  and  is,  therefore,  useful  to  relieve 
itching  of  skin  or  mucous  membrane.    It  contains 

Menthol,  a  stearopten,  which  occurs  in  colorless  crystals  having  the 
characteristic  odor  of  peppermint.  This  is  only  slightly  soluble  in  water, 
freely  soluble  in  alcohol,  ether,  chloroform  and  oils.  When  rubbed 
upon  the  skin  there  follows  a  decided  sensation  of  cold  to  the  part. 

It  is  a  useful  antiseptic  for  internal  administration  and  for  local 
dental  uses.  As  an  analgesic  antiseptic  it  may  be  dissolved  in  chloroform 
or  in  a  volatile  oil  for  use  in  pulp  treatment.  In  neuralgias  and  head- 
aches the  solid  crystal  is  rubbed  upon  the  skin  of  the  painful  area. 

Oleum  Sinapis  Volatile.    Volatile  Oil  of  Mustard. 

Oleum  Terebinthinae.     Oil  of  Turpentine. 

These  two  volatile  oils  have  been  discussed  in  their  more  important 
uses  as  irritants.  As  antiseptics  they  are  chiefly  used  externally  to  dis- 
infect the  skin  or  the  hands  of  the  operator  in  preparation  for  surgical 
operations.  Turpentine  is  more  applicable  to  the  skin  generally, 
while  for  hand  disinfection  flour  of  mustard  is  used  with  a  little  water 
in  order  to  develop  the  volatile  oil  directly  upon  the  surface  and  about 
the  nails, 

Terebenum.  Terebene,     The  reaction  between  oil  of  turpentine  and 


136  LOCAL   REMEDIES 

sulphuric  acid  yields  a  colorless  liquid,  known  as  terebene.  It  has 
an  agreeable  odor  and  aromatic  taste,  and  it  should  rank  among  the 
valuable  antiseptics  for  local  use.  It  is  almost  insoluble  in  water,  but  is 
soluble  in  3  parts  of  alcohol.  With  exposure  to  light  and  air  it  gradually 
acquires  an  acid  reaction.     It  is  used  internally  in  bronchitis. 

HALOGEN  GROUP. 

Bromum.  Bromine  [Br].  Besides  its  use  as  an  escharotic,  bromine  in 
aqueous  solution  (soluble  in  28  parts)  is  a  good  general  disinfectant,  but 
its  irritating  vapor  precludes  its  use  about  the  mouth  or  air  passages. 

Chlorine  [CI].  (For  internal  doses,  see  Index  of  Drugs.)  Pure  chlor- 
ine in  gaseous  form  is  too  irritating  and  poisonous  to  be  employed  except 
to  disinfect  rooms.  One  part  in  100  of  the  atmosphere,  with  moisture 
present,  is  an  efficient  germicide  for  disinfection  of  dwellings.  In  either 
of  the  official  preparations  it  is  available  for  tooth  disinfection  or  bleach- 
ing. It  is  also  a  deodorant  by  its  power  of  decomposing  sulphuretted 
hydrogen  compounds.  Its  disagreeable  odor  is  an  objection  to  its  use 
as  a  mouth-wash,  but  it  is  a  very  efficient  antiseptic.  Even  1  part  in 
22,000  has  been  found  capable  of  killing  developed  bacteria.*  Follow- 
ing are  the  commonly  used  chlorine  disinfectants : 

Liquor  Chlori  Compositus,  chlorine  water,  contains  about  0.4  per 
cent,  of  chlorine  gas. 

Liquor  Sodce  Chlorinatce,  Labarraque's  solution,  contains  at  least  2.4 
per  cent,  of  available  chlorine. 

Calx  Chlorinata,  chlorinated  lime,  contains  at  least  30  per  cent,  of 
available  chlorine. 

Incom'patihility.  Chlorine  gas  with  a  solution  of  ammonium  chloride 
forms  chloride  of  nitrogen,  which  is  explosive.  Chlorine  water  decom- 
poses ^potassium  iodide  in  solution,  liberating  iodine,  and  mixed  with  a 
solution  of  silver  nitrate  it  precipitates  chloride  of  silver.  In  contact 
with  silver  cyanide  it  liberates  hydrocyanic  acid.  It  oxidizes  organic 
substances  and  destroys  vegetable  colors.  Liquor  sodse  chlorinatse  is 
decomposed  by  hydrochloric  acid  with  evolution  of  chlorine  gas  and 
carbon  dioxide. 

lodum.  Iodine  [I].  This  substance  ranks  with  the  other  halogens 
as  a  powerful  antiseptic.  The  tincture  can  be  added  to  water  to  secure 
any  desired  strength,  a  weak  solution  being  suitable  as  an  irrigation  to 
pus  cavities.     As  an  inhalant  in  pulmonary  diseases,  when  a  powerful 

*  Brunton's  Pharmacology,  1885,  p.  96. 


ANTISEPTICS  137 

antiseptic  vapor  is  needed,  the  tincture  may  be  vaporized  with  steam 
in  a  strength  not  to  exceed  10  minims  (0.60  gm.)  to  a  pint  of  boihng 
water,  usually  combined  with  carboKc  acid,  eucalyptol  or  similar  drugs. 
In  its  other  uses  it  has  been  considered  under  Irritants. 

lodoformum.  Iodoform  [CHI3].  Obtained  by  the  action  of  iodine 
upon  alcohol  in  the  presence  of  an  alkali,  it  is  in  form  of  a  lemon-yellow 
crystalline  powder,  with  a  very  penetrating  odor  resembling  that  of  iodine. 
It  is  practically  insoluble  in  water,  soluble  in  47  parts  of  alcohol,  and  in 
5.2  parts  of  ether.  It  contains  96.7  per  cent,  of  iodine,  to  which  its 
antiseptic  power  has  been  supposed  to  be  due.  However,  Heile  *  finds 
that  the  value  of  iodoform  does  not  depend  upon  nascent  iodine,  but  upon 
a  much  more  active  substance,  diiodacetylidin,  which  is  set  free  from 
iodoform  in  contact  with  organic  substances  when  air  is  excluded. 
Iodoform  differs  from  iodine  in  being  non-irritant.  As  an  antiseptic 
dressing  it  is  applied  as  a  powder,  or  upon  gauze,  to  wounds  and  ulcers. 
Its  disagreeable  odor  precludes  its  use  in  dentistry;  but  a  number  of 
odorless  or  less  unpleasant  substitutes  have  been  introduced,  examples 
of  which  are  here  named,  the  first  and  second  being  now  official.  They 
are  all  nearly  insoluble  in  water. 

Thymol  Iodide  (Aristol),  containing  46.14  per  cent,  of  iodine. 

lodolum  (lodol),  containing  89  per  cent,  of  iodine. 

Antiseptol,  containing  50  per  cent,  of  iodine. 

Losophane,  containing  78  per  cent,  of  iodine. 

Sozoiodol,  containing  53  per  cent,  of  iodine,  20  per  cent,  carbolic 
acid,  and  7  per  cent,  sulphur.  This  substance  has  acid  combining  prop- 
erties and  forms  a  soluble  salt,  the  sodium  sozoiodolate. 


In  addition  to  the  above  group,  the  following  substance,  derived  from 
coal-tar,  holds  a  place  as  an  antiseptic  powder: 

Acetanilidum  [CgHgNO].  AcetaniHd,  a  white  crystalline  substance 
obtained  by  the  interaction  of  glacial  acetic  acid  and  aniline,  is  em- 
ployed in  very  fine  powder,  as  an  antiseptic,  by  being  dusted  upon 
wounds  after  surgical  operations.  Being  only  slightly  soluble,  it  is 
an  excellent  substitute  for  iodoform.  It  is  soluble  in  179  parts  of 
water  and  in  2.5  parts  of  alcohol. 

*  See  Gould's  Year-Book  of  Medicine,  1905,  p.  498. 


138  LOCAL  BEMELIES 


MISCELLANEOUS   ANTISEPTICS. 


Among  the  following  agents  will  be  found  none  of  the  ready-made 
proprietary  solutions  or  mixtures  that  are  advertised  so  largely  as  anti- 
septics. Such  are  entitled  to  no  place  in  a  book  that  aims  to  treat  sub- 
jects in  a  scientific  way,  for  the  basis  of  their  exploitation  is  commercial, 
and  their  use  should  be  regarded  as  unethical.  But,  aside  from  these 
considerations,  there  is  evidence  that  they  are  inferior  to  some  of  our 
well-known  simple  agents.  The  only  reason  for  a  reference  to  such 
preparations  here  is  in  order  to  discourage  their  use,  and  this  can  be 
done  upon  the  ground  of  their  inefficiency,  as  shown  below. 

In  a  very  important  series  of  observations  in  the  field  of  mouth  disin- 
fection, Wadsworth,*  working  in  connection  with  the  Health  Department 
of  New  York  City,  presents  a  comparison  of  the  antiseptic  power  of 
several  of  the  most  popular  of  the  proprietary  solutions  with  that  of 
alcohol. 

His  observations  were  made  with  the  pneumococcus,  which  is  so  fre- 
quently found  in  the  mouth.  He  found  that  this  bacterium  can  be 
readily  destroyed  in  a  broth  culture,  but  that  in  sputum  its  destruction 
by  harmless  solutions  is  extremely  difficult,  for  the  reason  that,  with 
many  antiseptics,  diffusion  into  sputum  or  into  an  exudate  is  hindered 
by  the  albuminous  matter.  Alcohol  proved  to  be  very  diffusive  and 
this  property  was  greatly  aided  by  the  addition  of  glycerin. 

The  observer's  conclusions  include  the  following  statement:  "Of 
all  the  commercial  solutions  studied — ^listerine,  borine,  borolyptol, 
glycothymoline,  odol  and  Seller's  solution — none  proved  efficient  when 
tested  on  pneumococci  under  the  conditions  most  favorable  for  their 
action.  Formalin,  lysol  and  hydrogen  peroxide  failed  to  act  upon  the 
pneumococci  in  exudates.  In  short,  alcohol  alone,  of  all  antiseptics 
studied,  proved  efficient  when  tested  on  the  pneumococci  under  all  the 
conditions  of  the  experiments." 

Alcohol  was  used  in  the  strength  of  20  to  40  per  cent.  Preference  is 
given  to  a  mixture  of  water,  glycerin  and  30  per  cent,  of  alcohol,  as  being 
readily  diffusible,  efficient  and  harmless. 

Betanaphtol.  Naphtol  [C10H7OH].  A  phenol  occurring  in  coal- 
tar,  but  usually  prepared  from  naphtalin.  It  occurs  in  colorless  or 
buff-colored  cr)'stals,  having  slight  odor  and  sharp  taste,  soluble  in 
950  parts  of  water  and  in  0.61  part  of  alcohol.     It  is  neutral. 

*  Journal  of  Infectious  Diseases,  October,  1906. 


ANTISEPTICS  '  139 

Betanaphtol  in  solution  is  useful  to  keep  instruments  sterile  during 
an  operation,  as  it  does  not  corrode  metals.  It  is  applied  as  an  anti- 
septic to  tissues,  from  the  1 :  950  saturated  aqueous  solution,  which 
may  be  used  to  irrigate  wounds  and  as  a  mouth  wash  freely,  to  the  full- 
strength  alcoholic  solution  (1:  0.61)  in  the  disinfection  of  root  canals. 
Upon  soft  tissues,  and  as  a  cleansing  and  disinfecting  agent  in  pyorrhea 
alveolaris,  a  1 :  200  or  1 :  300  solution  may  be  used,  prepared  either  with 
alcohol  or  hot  water,  for  it  is  soluble  in  75  parts  of  boiling  water.  A 
saturated  solution  in  hot  water,  allowed  to  cool  to  the  desired  point,  is 
very  useful ;  while  some  of  the  drug  precipitates  with  cooling,  the  solution 
will  be  saturated  at  whatever  temperature  used. 

Incom'patihility .  With  chlorine  water  or  bromine  water  betanaphtol 
will  produce  a  white  turbidity. 

Resorcinol.  Resorcin  [C6H602].  A  phenol  from  various  sources. 
Occurs  in  colorless  or  pinkish  crystals,  having  a  sweetish  taste,  soluble 
in  0.5  part  of  water  and  very  soluble  in  alcohol,  also  soluble  in  glycerin 
or  ether.  It  is  neutral  or  slightly  acid.  This  drug  is  useful  as  a  mouth 
antiseptic,  a  2  per  cent,  solution  in  water  being  a  proper  strength  for 
mouth  wash  or  gargle.  In  this  strength  it  is  frequently  employed  in 
whooping-cough  to  cleanse  the  throat  and  posterior  nares.  Although 
similar  to  phenol  in  action  and  uses,  it  is  not  corrosive  and  is  less  dan- 
gerous. The  internal  dose  is  double  that  of  phenol  and  it  can  be  used 
in  stronger  solution  (2  to  5  per  cent.)  for  general  antiseptic  purposes. 

Incompatibility.  The  aqueous  solution  of  resorcin  will  react  with 
chlorinated  lime,  ferric  chlorid    or  bromine  water. 

:^  Potassii  Chloras.  Chlorate  of  Potassium  [KCIO3].  Occurs  in 
colorless  crystals  or  white  powder,  odorless,  and  having  a  salty  taste. 
It  is  neutral,  soluble  in  16  parts  of  water,  insoluble  in  absolute  alcohol. 

The  U.  S.  P.  advises  caution  with  this  salt,  as  explosion  may  occur 
when  it  is  mixed  with  organic  matter  (tannic  acid,  sugar,  etc.),  or  with 
sulphur,  phosphorus  or  other  easily  oxidizable  substances. 

It  is  not  a  strong  antiseptic,  a  3  per  cent,  solution  failing  to  prevent 
the  development  of  bacteria.  In  mercurial  or  other  forms  of  stomatitis 
it  is  used  in  saturated  solution  as  a  mouth-wash,  or  in  tablet  form  it  is 
allowed  to  dissolve  slowly  in  the  mouth.  It  is  also  valued  highly  as 
an  internal  remedy  in  aphthous  stomatitis.  The  dosage  should  be  mod- 
erate because  of  possible  deleterious  effect  upon  the  blood,  as  it  may 
change  hemoglobin  into  methemoglobin.    Dose,  gr.  1-10  (gm.  0.06-0.60). 

Incompatibility.  Besides  the  dangers  mentioned  above,  the  drug  is 
incompatible  with  strong  sulphuric  and  hydrochloric  acids.     (A  drop  of 


140  LOCAL  REMEDIES 

sulphuric  acid  will  ignite  a  mixture  of  equal  parts  of  potassium  chlorate 
and  sugar.)     An  aqueous  solution  precipitates  with  nitrate  of  silver. 

Potassii  Permanganas.  Permanganate  of  Potassium  [KMnOJ. 
Occurs  in  dark  purple  crystals,  having  a  characteristic,  unpleasant  taste, 
neutral,  soluble  in  15  parts  of  water.  It  decomposes  in  contact  with 
alcohol.  Being  a  powerful  oxidizing  agent  the  U.  S.  P.  directs  that  it 
should  be  kept  in  glass-stoppered  bottles,  protected  from  light,  and  should 
not  be  brought  in  contact  with  organic  or  readily  oxidizable  substances. 
Its  oxidizing  power  makes  it  a  valuable  disinfectant  and  deodorant. 
Applied  to  the  mucous  membrane  of  the  mouth  in  proper  dilution  it  is 
non-irritant,  but  it  produces  a  dirty  brown  stain,  which  is  an  objection 
to  its  use.  However,  the  stain  is  easily  removed  from  accessible  sur- 
faces by  a  solution  of  oxalic  acid.  It  may  be  applied  locally  in  any 
strength  up  to,  or  even  above,  5  per  cent.  Its  action  is  quite  superficial 
and  is  to  be  explained  by  the  fact  of  the  liberation  of  oxygen,  which 
unites  with  the  albumin  of  the  tissues.  Very  strong  solutions,  therefore, 
may  be  irritating  and  even  somewhat  caustic  to  mucous  membranes. 
It  has  been  found  efficient,  and  has  been  extensively  used  by  surgeons, 
as  a  hand  disinfectant  in  preparation  for  operating.  After  preliminary 
scrubbing  of  the  hands  and  nails  with  soap  and  water,  they  are  immersed 
in  a  saturated  aqueous  solution  of  the  permanganate.  This  is  followed 
by  a  solution  of  oxalic  acid  which  removes  the  stain  of  the  permanganate. 
When  used  as  a  mouth  wash,  1:  1000  is  a  proper  dilution.  Its  use 
within  a  carious  cavity  is  always  to  be  avoided;  other  agents  are  just 
as  efficient,  without  the  objectionable  staining  quality.  As  an  applica- 
tion to  the  throat  in  diphtheria  or  tonsillar  infection,  and  to  foul  ulcers, 
it  possesses  considerable  value.  In  1  per  cent,  solution  it  has  been 
found  to  destroy  developed  bacteria  and  in  1  :  1000  it  prevents  their 
development.*  It  is  an  efficient  chemical  antidote  to  morphine  if  given 
while  the  latter  is  still  in  the  stomach. 

Incompatibility.  With  organic  substances,  or  triturated  with  sulphur 
or  other  inflammable  substances,  explosion  may  occur.  With  carbolic 
acid  oxidation  occurs.     Alcohol  decomposes  it. 

This  drug  should  be  used  cdone  in  a  simple  aqueous  solution. 
Sodii  Sulphis.  Sulphite  of  Sodium  [NaaSOg  +  7H2O].  Exposed 
to  the  air  this  salt  is  efflorescent  and  gradually  oxidizes  to  sulphate. 
It  is  soluble  in  2  parts  of  water,  the  solution  being  either  neutral  or 
feebly  alkaline;  slighdy  soluble  in  alcohol.  It  may  be  used  as  a 
bleaching  agent,  acting  by  the  abstraction  of  oxygen  from  the  color- 
ing matter.     (See  undjer  Bleaching  Agents.) 

*  Brunton's  Pharmacology,  1885,  p.  96. 


ANTISEPTICS  141 

Sodii  Thiosulphas.  Thiosulphate  of  Sodium.  Hyposulphite  of 
Sodium  [Na2S203  +  5H20].  This  salt  is  soluble  in  less  than  1  part  of 
water  and  the  solution  is  neutral ;  insoluble  in  alcohol.  Its  antiseptic 
power  makes  it  a  useful  mouth  wash.  It  is  also  a  useful  internal  anti- 
septic. Weisse  employs  the  hyposulphite  to  treat  abscess  cavities, 
by  packing  with  gauze  saturated  in  a  solution  of  5j  to  fSj  of  water 
(12|  per  cent.). 

Zinci  Chloridi.  Chloride  of  Zinc.  (For  general  properties,  see 
under  Escharotics.)  This  substance,  on  account  of  its  germicidal  and 
penetrating  power,  must  be  ranked  among  our  best  antiseptics.  The 
disadvantages  in  its  use  are  the  irritation  it  causes  and  its  coagulant 
action.  For  tooth  disinfection,  especially  in  pulpless  teeth,  these  dis- 
advantages do  not  obtain,  and  strong  solutions  (above  20  per  cent.) 
may  be  used;  while  for  mouth  disinfection  weak  solutions  are  employed 
(1  to  5  per  cent.).  It  must  be  remembered  that  its  coagulation  of 
albuminous  matter  liberates  hydrochloric  acid,  which  should  not  remain 
about  the  teeth,  but  must  be  neutralized  at  once. 

Argenti  Nitras.  Nitrate  of  Silver  [AgNOg].  Although  generally 
inadmissible  as  a  mouth  or  tooth  antiseptic  because  of  its  staining 
quality,  this  drug  is  valuable  in  severe  local  infections  of  the  mucous 
membrane.  It  is  destructive  to  the  gonococcus  wherever  found,  and 
in  that  severe  form  of  conjunctivitis  known  as  ophthalmia  neonatorum, 
which  is  usually  a  gonorrheal  infection  of  the  eyes  occuring  during  birth, 
nitrate  of  silver  is  most  relied  upon  as  the  germicide.  Also,  in  order  to 
prevent  this  serious  malady,  the  advice  of  Crede*  should  be  supported 
and  followed,  which  is,  that  the  eyes  of  all  babes  born  in  charitable 
institutions  should  invariably  have  a  2  per  cent,  solution  of  silver  nitrate 
instilled  into  them  immediately  after  birth,  so  as  to  disinfect  every  part 
of  the  conjunctival  membrane.  As  evidence  of  the  efficacy  of  such 
preventive  treatment,  it  may  be  noted  that  the  statistics  of  large  lying-in 
institutions  where  it  has  been  employed,  show  that  the  Crede  method 
has  reduced  the  disease  to  less  than  one-fifteenth  of  its  former  preva- 
lence in  the  same  institutions.  Whenever  nitrate  of  silver  is  locally 
applied  any  excess  may  be  completely  neutralized  by  a  solution  of 
sodium  chloride. 

*  The  justification  for  this  advice  is  found  in  the  large  percentage  of  cases  of  blind- 
ness that  are  due  to  this  severe  inflammation,  occurring  as  a  result  of  infection  of  the 
eyes  at  birth.  In  1897  an  investigation  of  the  causes  of  blindness  of  the  308  inmates 
of  the  schools  for  the  blind  in  New  York  State  showed  that  21  per  cent,  of  cases 
were  due  to  ophthalmia  neonatorum.  Howe,  Transactions  of  the  Medical  Society  of 
the  State  of  New  York,  1897.  ■»  ^ 


142  LOCAL  REMEDIES 

Certain  other  preparations  of  silver  have  been  found  to  be  highly 
antiseptic  and  have  come  into  use  in  general  surgery.  Of  these  the 
most  remarkable  is  an  allotropic  form  of  metallic  silver  that  is  soluble 
in  water  and  in  albuminous  fluids.  The  aqueous  solution  of  this  (usually 
1  per  cent.)  may  be  injected  into  infected  tissues,  or  even  intravenously 
in  cases  of  septicemia.  It  is  also  used  in  form  of  ointment  rubbed  into 
the  skin.    The  following  are  also  now  employed  in  general  surgery: 

Silver  Lactate.  Actol  [AgCgHgOg  +  HgO].  A  white  powder,  soluble 
in  20  parts  of  water,  said  to  be  an  efficient  germicide  in  1 :  1000  solution. 

Silver  Citrate.  Itrol.  A  white  powder,  slightly  soluble  in  water, 
said  to  be  destructive  to  all  ordinary  germs  when  used  in  a  solution 
of  1 :  4000.  The  solution  should  be  freshly  prepared.  It  is  also  used 
in  ointment  of  1  to  2  per  cent,  strength. 

Protargol.  This  substance  is  a  silver  albumose,  containing  8  per  cent, 
of  metallic  silver.  It  is  a  yellowish  powder,  readily  soluble  in  water,  and 
is  less  irritating  than  nitrate  of  silver.  The  reason  for  this  probably  is 
that,  being  an  albumin  compound,  its  application  to  tissues  is  not  fol- 
lowed by  the  liberation  of  an  acid,  as  is  the  case  with  the  nitrate.  It 
destroys  various  bacteria,  and  it  has,  therefore,  come  to  be  used  much 
as  a  substitute  for  the  nitrate  in  purulent  inflammations  of  mucous 
membranes,  particularly  when  they  are  gonorrheal  in  nature.  One 
to  5  per  cent,  is  the  strength  of  solution  in  which  it  is  employed.  A 
number  of  other  organic  preparations  of  silver  have  been  introduced 
under  various  names;  but  protargol  is  quite  representative  of  the  class, 
possessing  the  essential  advantages  claimed  for  them. 

Preparations  -of  silver  have  been  used  internally,  especially  the  nitrate 
and  oxide,  for  alterative  effect.  It  must  be  noted  that  the  prolonged 
internal  use  of  this  metal  should  be  discouraged.  It  is  capable  of  pro- 
ducing a  permanent  staining  of  tissues,  which  is  outwardly  shown  by  a 
slight  blueness  of  the  skin.  This  condition  is  known  as  argyria  and  is 
due  to  the  deposit  of  silver  in  the  papillary  layer  of  the  skin.  The  same 
condition  may  be  produced  in  a  smaller  area  by  the  local  use  of  silver 
preparations,  where  they  are  allowed  to  enter  the  tissues. 

Hydrargyri  Chloridum  Corrosivum.  Mercuric  Chloride.  Bichloride 
of  Mercury.  Corrosive  Sublimate.  Perchloride  of  Mercury  [HgClJ. 
This  substance  occurs  in  colorless,  odorless  crystals,  having  a  dis- 
agreeable metallic  taste,  soluble  in  13  parts  of  water,  in  3  parts  of 
alcohol,  and  in  about  14  parts  of  glycerin.  It  is  acid  in  reaction,  although 
the  addition  of  chloride  of  sodium  to  its  aqueous  solution  will  render  it 
alkaline.    Because  of  its  corrosive  properties,  for  general  antiseptic  pur- 


ANTISEPTICS  143 

poses  it  is  used  only  in  dilute  solution  of  1 :  2000  to  1 :  10,000.  However, 
for  limited  use  as  a  powerful  disinfectant,  it  may  be  used  as  strong  as 
1:  1000  or  even  1:  500  in  the  mouth,  as  in  plantation  cases. 

This  drug  may  cause  poisoning  in  two  ways,  either  as  a  corrosive 
by  local  destruction  of  tissue,  or,  after  absorption,  as  a  systemic  poison. 
In  the  former  case  a  strong  solution  or  the  pure  salt  is  necessary  to  cause 
poisoning,  while  in  the  latter  case  small  doses  continued,  or  careless 
use  of  ordinary  solutions  or  of  any  preparation  of  mercury,  is  likely  to 
cause  systemic  mercurial  poisoning,  with  the  production  of  salivation. 
For  example,  a  single  cathartic  dose  of  calomel,  or  the  daily  use  of  the 
compound  cathartic  pills,  which  contain  one  grain  of  calomel  each,  has 
caused  salivation. 

This  powerful  drug  will  seldom  be  the  antiseptic  of  first  choice  in 
dental  practice.  Its  unpleasant,  metallic  taste  prevents  its  use  as  a 
mouth-wash.  As  a  tooth  disinfectant  it  is  seldom  used  because  of  the 
danger  of  staining  the  tooth  through  the  formation  of  sulphide  of 
mercury.*  It  corrodes  instruments,  therefore  cannot  be  used  to  sterilize 
them,  although  glassware  may  be  easily  sterilized  by  the  solution  of 
1:1000. 

In  spite  of  all  disadvantages  mercuric  chloride  remains  as  one  of  the 
most  efficient  germicides.  In  general  medicine  and  surgery  the  weaker 
solutions  (1 :  3000  to  1 :  10,000)  are  used  cautiously  and  for  a  short  time, 
to  irrigate  wounds  and  abscess  cavities,  to  disinfect  ulcers,  and  as  douches 
into  the  several  passages  of  the  body.  Whenever  used,  a  free  escape  of 
the  solution  must  be  insured,  and  its  use  in  these  ways  should  rather 
be  regarded  as  a  temporary  necessity,  to  be  supplanted  by  safer  agents. 
As  a  rule,  it  should  not  be  combined  with  other  substances. 

Incompatibility.  Mercuric  chloride  mixed  with  lime-water,  ammonia 
or  carbonates  of  the  alkalies,  will  produce  a  precipitate.  With  a  solution 
of  soap  a  precipitate  of  mercurial  soap  occurs.  With  potassium  iodide 
red  iodide  of  mercury  is  formed.  Hydrogen  sulphide  causes  a  black 
precipitate  of  mercuric  sulphide.  With  silver  nitrate  a  deposit  of  chloride 
of  silver  occurs.  Metals  are  tarnished  by  it,  amalgamation  occurring 
with  silver  and  some  others.    Albumin  is  coagulated  by  it. 

Acute  Poisoning.  The  symptoms  of  acute  poisoning  by  this  drug  are 
those  produced  by  any  corrosive  irritant — i.  e.,  pain  in  the  stomach, 
with  vomiting  and  prostration.  The  chemical  antidote  is  albumin. 
(See  Table  of  Poisons  and  Antidotes.) 

*  See  remarks  on  metallic  stains  in  Kirk's  article  on  "  Discolored  Teeth  and  their 
Treatment,"  American  Text-book  of  Operative  Dentistry,  second  edition,  page  559. 


144  LOCAL  REMEDIES 

Systemic  Poisoning  or  Mercurialism.  Only  the  soluble  salts  of  mercury 
are  capable  of  causing  local  irritation,  but  any  preparation  of  this  metal 
may  cause  mercurialism.  The  symptoms  of  this  condition  may  come 
on  without  any  gastric  disturbance;  in  fact,  it  is  fortunate  that  the 
first  indications  of  systemic  saturation  occur  in  the  mouth,  where  they 
are  at  once  noticed  and  easily  recognized;  and  the  dentist  should  be 
familiar  with  the  early  symptoms  of  this,  possibly  disastrous,  toxic 
disturbance. 

The  first  symptom  will  be  h}'peremia  of  the  more  vascular  structures, 
the  pericementum  and  gums,  causing  in  the  former  slight  tenderness 
upon  forcible  closure  of  the  jaws,  and  in  the  latter  redness.  If  the 
condition  progresses,  the  soreness  of  the  teeth  becomes  decided  and 
an  increased  flow  of  saliva  occurs,  with  decided  fetor  of  the  breath. 
This  gives  us  the  picture  of  salivation  in  positive  degree;  fortunately 
the  superlative  degree,  with  ulceration  and  loss  of  teeth,  is  almost  never 
seen  to-day  because  of  smaller  quantities  of  the  drug  now  given,  with  the 
decline  of  the  antiphlogistic  methods  of  treatment  which  were  formerly 
in  vogue.  The  elimination  of  mercury  in  the  saliva,  from  a  system 
saturated  with  it,  is  probably  responsible  for  the  occurrence  of  the 
ulcerative  stomatitis  seen  in  severe  cases.  Right  here  let  it  be  stated 
that  detection  by  the  dentist  of  the  early  symptoms  of  mercurialism 
should  call  forth  no  reflection  upon  the  physician  who  prescribed 
mercurv.  This  for  two  reasons :  First,  the  condition  may  have  occurred 
accidentally  through  idiosyncrasy — i.  e.,  a  special  susceptibility  of  the 
patient  to  the  action  of  the  drug,  which  is  sometimes  seen.  Second,  the 
condition  may  be  intentional,  for,  in  the  treatment  of  secondary  syphilis, 
it  is  usual  to  push  the  drug  to  saturation  at  first,  then  from  that  point 
to  diminish  the  dose  to  that  proper  for  the  individual  to  continue. 

Treatment  of  Mercurialism.  The  patient  will  complain  of  two  symp- 
toms if  the  condition  is  well  developed:  First,  soreness  of  the  teeth,  and 
second,  the  constant  flow  of  saliva  which  may  interfere  with  sleeping. 
These  will  need  to  be  relieved.  Relief  of  the  pericementitis  and  stom- 
atitis must  be  brought  about  by  elimination  through  other  channels 
than  the  salivar)^  and  oral  glands.  The  bowel  being  the  most  natural 
route  for  the  elimination  of  mercury,  saline  cathartics,  freely  given,  by 
their  power  of  withdrawing  serum  from  the  blood,  will  serve  our  purpose 
best.  The  salivation  may  be  controlled  by  belladonna  or  its  alkaloid, 
atropine.  Of  the  tincture  give  5  minims  (gm.  0.30),  or  of  atropine 
gr,  _^  (gm.  0.0006)  two  or  three  times  daily.  This  is  the  best  drug  for 
this  purpose,  as  it  checks  the  salivary  secretion  very  decidedly  and  is 


ANTISEPTICS  145 

not  disturbing  to  the  system  if  used  properly.  Opium  and  morphine 
also  cause  dryness  of  the  mouth,  but  their  systemic  effects  are  unpleasant, 
and  on  the  whole  they  are  inferior  to  belladonna.  A  mouth  wash  of 
solution  of  potassium  chlorate  (2  to  4  per  cent.)  is  often  used  in  addition. 
Reports  have  recently  been  made  of  the  very  successful  use  of  hydrogen 
dioxide  in  this  condition.  One  part  of  the  official  solution  to  3  of  water, 
as  a  mouth  wash  every  half-hour,  is  recommended.  Its  peculiar  detergent 
property  makes  it  particularly  applicable  to  severe  cases,  where  ordinary 
antiseptics  are  less  useful.  With  improvement  in  the  condition,  the 
saline  cathartics  should  still  be  continued  until  the  drug  is  believed 
to  have  been  thoroughly  eliminated.  Potassium  iodide  has  long  been 
used  to  aid  elimination  of  this  as  of  other  heavy  metals.  The  dose 
is  10  to  30  grains  (gm.  0.60-2)  three  times  daily.  It  is  believed  to  form 
the  more  soluble  iodide,  which  then  passes  out  through  the  kidneys. 

Carbo  Ligni.    Wood  Charcoal.    Employed  as  deodorant. 

Oarbo  Animalis.  Animal  Charcoal.  Prepared  from  bone;  employed 
as  a  decolorizing  agent  in  preparing  organic  solutions. 

Carbo  Animalis  Purificatus.  Purified  Animal  Charcoal.  The  puri- 
fication consists  in  decalcifying  by  boiling  for  hours  in  hydrochloric  acid 
diluted  with  water.     It  is  employed  as  an  antidote  to  organic  poisons. 

Charcoal  of  any  kind  is  not  really  antiseptic,  but  it  is  deodorant  and 
detergent  and  has  marked  absorbent  power.  Obviously  its  application 
to  mouth  conditions  is  limited,  though  its  general  value  should  be 
appreciated. 

Wood  charcoal,  prepared  from  soft  wood  because  more  porous,  is 
least  powerful  of  the  group,  but  it  has  the  power  of  absorbing  gases  to 
a  large  extent — e.  g.,  it  is  said  to  be  capable  of  absorbing  ninety  times 
its  own  volume  of  ammonia  gas.  It  destroys  foul  gases  by  absorbing 
and  condensing  them  within  its  pores.  This  power  may  be  increased 
by  platinizing  the  charcoal. 

In  order  to  be  an  efficient  deodorant,  wood  charcoal  must  either  be 
fresh,  or  have  been  recently  heated  so  as  to  destroy  organic  impurities 
that  may  have  been  taken  up  through  exposure  to  the  air. 

Animal  charcoal  is  a  more  powerful  absorbent,  being  capable  of 
extracting  coloring-matters  from  organic  solutions.  It  may  be  used 
in  decolorizing  galenical  preparations  of  drugs. 

Purified  animal  charcoal  is  too  powerful  to  use  in  decolorizing  solutions 
of  drugs,  for  it  is  capable  of  extracting  organic  principles,  such  as 
alkaloids  and  resins,*  whereby  the  strength  of  the  product  would  be 

*  U.  S.  Dispensatory,  eighteenth  edition,  page  329. 
10 


146  LOCAL  REMEDIES 

lessened.     Because  of  this  behavior  toward  organic  principles,  purified 
animal  charcoal  has  been  proposed  as  an  antidote  to  organic  poisons. 

All  charcoals  should  be  kept  in  well-closed  containers,  so  that  their 
absorbent  power  may  not  be  exhausted  by  absorption  of  gases  from 
the  atmosphere. 

Dental  Uses.  About  the  only  use  to  which  charcoal  could  be  properly 
put  is  to  cleanse  a  foul  mouth,  such  as  is  too  often  met  with  among 
ignorant  people.  Its  practical  application  is  questionable.  It  is  not  a 
proper  ingredient  of  tooth  powders,  because  of  the  sharpness  of  its 
particles. 

Hydrogen  Dioxide.  This  compound,  having  the  chemical  formula  of 
H2O2,  is  used  in  several  strengths  as  an  antiseptic.  Its  value  depends 
upon  the  extra  oxygen  which  it  contains  and  which  it  gives  up  readily 
when  brought  into  conditions  that  favor  its  decomposition.  It  is, 
therefore,  an  oxidizing  agent,  the  oxygen  liberated  in  nascent  condition 
giving  it  three  distinct  properties  which  make  it  especially  valuable  in 
dental  practice,  it  being  a  disinfectant,  a  detergent  and  a  bleaching 
agent. 

A  compound  that  yields  its  oxygen  so  readily  is,  of  course,  unstable; 
but  it  has  been  found  that  a  solution  containing  3  per  cent,  of  pure 
hydrogen  dioxide  in  water  keeps  its  strength  and  qualities  for  months 
at  ordinary  temperatures.  Higher  strength  solutions  require  the  addition 
of  considerable  acid  or  other  preservative,  and  must  be  looked  upon 
as  unstable  and  dangerous  to  handle.  A  25  per  cent,  ethereal  solution 
is  put  up  in  closed  glass  tubes  with  certain  precautions  noted  upon 
the  label.  In  this  strength  the  agent  is  a  decided  caustic  and  must  be 
handled  with  care.    It  is  used  chiefly  as  a  bleaching  agent. 

The  official  solution  is  called 

Aqua  Hydrogenii  Dioxidi.  Solution  of  Hydrogen  Dioxide  [HgOj]. 
This  is  a  colorless  liquid,  slightly  acid  in  reaction,  and  it  contains,  when 
freshly  prepared,  about  3  per  cent.,  by  weight,  of  the  pure  dioxide, 
corresponding  to  about  ten  volumes  of  available  oxygen.  It  is  some- 
times known  as  the  "ten  volume"  solution,  as  it  yields  upon  decom- 
position about  ten  times  its  own  volume  of  oxygen.  The  acid  it  contains 
is  necessary  to  its  preservation. 

The  most  characteristic  property  of  this  liquid  is  its  foamy  decom- 
position in  contact  with  organic  matter,  by  the  activity  of  which  its 
strength  can  be  roughly  estimated. 

It  gradually  loses  strength  by  keeping,  though  it  is  stated  that 
deterioration  will  be  retarded  if  a  stopper  of  cotton  be  used  in  the 


ANTISEPTICS  147 

bottle   instead   of   an  ordinary  stopper.     It  should   be  kept   in  a  cool 
place. 

It  decomposes  when  heated  or  exposed  to  sunlight,  also  when  in 
contact  with  charcoal,  oxides  of  manganese,  'potassium  'permanganate, 
alkalies,  blood,  pus  and  other  loosely  organized  matter,  besides  many 
other  chemical  substances.  Mixed  with  a  solution  of  potassium  iodide 
it  liberates  iodine.  As  a  rule,  it  should  be  used  alone,  so  as  to  avoid 
unexpected  decomposition. 

When  the  3  per  cent,  solution  is  applied  to  the  tissues  it  decomposes 
with  some  energy,  because  of  the  rapidity  and  abundance  of  the  libera- 
tion of  oxygen.  Upon  a  tender  mucous  membrane  the  action  may  be 
so  irritating  as  to  require  dilution  of  the  liquid.  The  oxygen  in  nascent 
condition  is  a  powerful  germicide  and  disinfectant,  cleansing  the  surface 
of  the  tissue  thoroughly  without  injury,  for  it  does  not  coagidate,  nor 
constringe,  nor  penetrate.  Its  action  is  solely  that  of  an  oxidizing  agent, 
and  any  irritation  from  it  corresponds  to  the  energy  of  oxygen  liberation. 
As  a  gargle  or  mouth  wash  it  may  be  employed  in  full  strength  of  the 
official  solution  (3  per  cent.)  or  diluted.  With  children  it  is  usually 
diluted  to  one-half  or  one-quarter  strength. 

It  should  be  regarded  distinctively  as  an  antiseptic  that  does  not 
injure  healthy  tissues.  Its  special  value  lies  in  its  power  to  oxidize, 
disintegrate  and  destroy  disorganized  tissue,  such  as  pus;  and  in  dis- 
infecting abscess  cavities  it  has  the  further  advantage  of  distending  the 
cavity  by  the  expansion  resulting  from  the  liberation  of  oxygen,  so  that 
every  portion  of  the  cavity  and  its  walls  are  reached  by  the  oxygen. 
By  free  use  with  repeated  injection,  it  should  be  possblie  to  reach  and 
destroy  every  particle  of  pus  and  of  disorganized  tissue.  Distention  of 
an  abscess  cavity  in  this  way  will  cause  momentary  pain,  but  scarcely 
more  than  attends  the  use  of  a  coagulating  or  penetrating  antiseptic. 

In  tooth  and  root-canal  disinfection  the  dioxide  is  used  freely.  In 
removing  pus  and  cleansing  the  pockets  in  pyorrhoea,  in  the  cleansing 
of  ulcers  and,  in  fact,  in  any  local  infectious  condition,  hydrogen  dioxide 
is  an  ideal  disinfectant.  But  the  mistake  should  not  be  made  of  expect- 
ing of  this  substance  properties  that  it  does  not  possess.  It  is  not  antacid 
it  is  not  coagulant,  it  is  not  astrijigent,  it  does  not  affect  healthy  tissue. 
Its  action  is  upon  disorganized  tissue,  blood,  pus  and  bacteria.  The 
one  indication  for  its  use  is  the  presence  of  infection.  One  exception 
must  be  made  under  the  general  statements  as  to  its  use  in  abscess 
cavities:  it  should  not  be  used  in  the  antrum  with  its  unyielding  bony 
wall,  unless  a  very  free  opening  has  been  made.     Very  severe  pain 


148  LOCAL  REMEDIES 

might  easily  attend  its  use  ordinarily  in  empyema  of  the  antrum,  on  ac- 
count of  pressure  from  the  rapid  expansion  of  the  liberated  oxygen. 

Systematic  effects  never  occur  from  the  proper  use  of  hydrogen 
dioxide;  therefore,  it  is  non-toxic.  However,  by  its  hypodermic  use  some 
of  the  unchanged  dioxide  may  be  absorbed  into  the  circulation  and 
cause  disorganization  of  blood  elements  with  the  production  of  emboli. 
An  animal  may  easily  be  killed  by  intravenous  injection  of  dioxide  of 
hydrogen. 

The  use  of  this  substance  as  a  bleaching  agent  is  discussed  else- 
where. 

Formaldehyde  [HCO.H].  This  valuable  recent  addition  to  our  materia 
medica  is  a  gas,  usually  obtained  by  the  partial  oxidation  of  methyl 
alcohol.  It  is  one  of  the  most  powerful  disinfectants  known,  ranking 
with  corrosive  sublimate.  It  fills  a  place  that  no  other  agent  does  as  a 
really  effective  and  practicable  disinfectant  gas.  It  is  far  superior  to  sul- 
phurous acid  gas  in  respect  of  efficiency,  penetrating  power  and  non- 
action upon  metallic  furnishings.  Various  lamps  and  other  apparatus  for 
generating  the  gas  for  extensive  use  have  been  desired,  and  small  fumi- 
gators  or  candles  for  limited  use,  as  in  the  disinfection  of  books,  instru- 
inents  and  clothing  in  a  small  air  space.  The  gas  is  very  irritating  to 
the  eyes  and  to  the  air  passages.  As  a  medicinal  agent  formaldehyde 
is  employed  in  its  official  aqueous  solution,  as  below. 

Liquor  Formaldehydi.  Solution  of  Formaldehyde.  Formalin. 
This  is  an  aqueous  solution  containing  about  40  per  cent,  (not  less 
than  37  per  cent.,  U.  S.  P.)  of  formaldehyde  gas.  It  has  a  pungent  odor 
and  caustic  taste,  being  irritant  to  tissues.  It  is  the  commercial  form 
of  the  drug  and  is  miscible  with  water  and  with  alcohol  in  any  propor- 
tion. It  should  be  neutral  or  only  faintly  acid  in  reaction.  Upon 
standing  it  may  become  cloudy  from  the  separation  of  paraformalde- 
hyde. A  stronger  solution  is  unstable.  A  much  weaker  solution  must 
be  used  for  application  to  living  tissues,  for  this  substance  is  charac- 
terized by  its  'penetrating  quality  and  irritant  action. 

While  this  drug  has  the  power  to  harden  tissues  to  a  marked  degree, 
the  action  is  not  a  coagulation  in  the  ordinary  sense.  When  applied  to 
a  mucous  membrane,  it  does  not  coagulate  appreciably.  In  contact  with 
egg  albumin  it  coagulates  the  latter  only  slightly.  It  fact,  it  seems  to 
hinder  the  coagulation  of  albuminous  liquids  to  which  it  has  been  added; 
for  egg  albumin  and  serum  are  not  precipitated  by  heat,  nor  is  casein 
coagulated  by  the  rennet  enzyme,  after  being  thus  treated.*  Compared 
*  Cushny's  Pharmacology,  3d  edition,  p.  429, 


ANTISEPTICS  149 

with  carbolic  acid,  the  local  action  of  formalin  is  less  corrosive  and 
more  penetrating;  it  is  on  the  whole  more  irritating,  except  for  the 
momentary  pain  caused  by  the  former.  The  result  of  its  action  is  a 
deeper  hardening  of  the  tissues  to  which  it  is  applied.  Because  of  the 
continued  irritation  which  it  occasions,  it  cannot  be  used  extensively 
as  a  general  antiseptic  to  the  soft  tissues,  except  in  very  dilute  solution. 
Even  for  disinfection  of  the  hands,  it  has  been  largely  discarded  as  being 
too  irritating  for  daily  use.  As  a  mouth-wash,  \  per  cent,  of  formalin 
should  never  be  exceeded.  For  disinfection  of  pulpless  teeth  5  per  cent, 
may  be  used.  Although  this  drug  has  not  fully  found  its  place  in  den- 
tistry, its  qualities  of  penetrating  and  gradually  hardening  tissue  would 
entitle  it  to  thorough  trial  for  purposes  of  pulp  disinfection  and  mummi- 
fication. 

On  the  whole,  it  must  be  said  that  formalin  is  not  gaining  favor  as  a 
general  antiseptic  for  application  to  the  tissues  of  the  body.  The  experi- 
ments of  Hunt  and  Jackson*  rate  the  1 :  200  solution  of  formalin  as  far 
inferior  to  the  same  strength  of  benzoic  acid  and  to  1 :  2500  solution 
of  mercuric  chloride  for  mouth  disinfection.  Harrington  found  that  a 
1  per  cent,  solution  of  formaldehyde  failed  to  kill  the  staphylococcus 
pyogenes  aureus  in  sixty  minutes,  while  a  2  per  cent,  solution  required 
forty-five  minutes,  and  a  5  per  cent,  solution  twenty  minutes  to 
destroy  the  same  organism. f 

As  an  agent  to  prevent  the  growth  of  mouth  bacteria.  Peck  found 
pure  formaldehyde  in  1 :  1000  solution  hardly  one-fourth  as  potent  as 
the  same  strength  of  bichloride  of  mercury  solution.! 

An  important  use  of  formaldehyde  is  in  the  hardening  and  preserva- 
tion of  anatomic  and  pathologic  specimens.  A  5  per  cent,  solution  of 
formalin  is  commonly  employed.  The  advantages  of  this  agent  over 
alcohol  is  that  the  color  of  the  specimen  is  better  retained,  and  the 
tissue  does  not  shrink  to  any  great  degree. 

Hexamethylenamina.  Urotropin  [C6H12N4].  This  substance  is  a 
chemical  compound  of  formaldehyde  and  ammonia.  It  occurs  in  color- 
less crystals  which  are  soluble  in  1.5  parts  of  water  and  in  10  parts  of 
alcohol.  The  aqueous  solution  is  alkaline.  The  chief  value  of  uro- 
tropin is  as  an  antiseptic  to  the  urinary  tract.  The  explanation  of  its 
action  is,  that  when  eliminated  by  the  kidneys  it  is  decomposed  into 
formaldehyde  and  ammonia,  the  former  acting  then  as  an  antiseptic. 
It  is  a  very  efficient  agent. 

*  Transactions  of  the  Dental  Society  of  the  State  of  New  York,  1904,  p.  94. 
t  Annals  of  Surgery,  October,  1904. 
t  Dental  Review,  August,  1898,  p.  607. 


CHAPTEE  XII. 

BLEACHING  AGENTS. 

The  art  of  removing  discolorations  of  the  teeth  has  for  years  engaged 
some  of  the  best  thought  of  the  dental  profession,  with  the  result  that 
today  we  may  say  that  the  bleaching  of  teeth  has  become  a  science. 
With  causes  of  discoloration  well  known  and  properly  classified,  the 
chemical  reactions  necessary  to  discharge  the  color  may  usually  be 
secured  with  certainty.  Moreover,  the  appreciation  on  the  part  of  the 
patient  is  usually  commensurate  with  the  effort  expended. 

The  excellent  chapter  on  "Discolored  Teeth  and  their  Treatment," 
by  Dr.  Kirk,  in  the  American  Text-hook  of  Operative  Dentistry,  gives  a 
systematic  presentation  of  present-day  knowledge  of  methods  of  bleach- 
ing discolored  teeth,  which  must  stand  as  the  authority  of  to-day  upon 
this  special  subject.  The  province  of  the  chapter  here  presented  is  to 
deal  with  substances  rather  than  detailed  methods  of  their  application. 
The  chief  agents  employed  to  bleach  teeth  are  discussed,  therefore,  as 
to  their  properties,  action  and,  in  general,  their  uses. 

There  must  necessarily  be  a  chemical  basis  for  the  action  of  these 
agents,  for  it  is  inconceivable  that  colors  could  be  discharged  by  the 
action  of  such  strong  chemicals  as  chlorine  and  nascent  oxygen  without 
the  occurrence  of  chemical  reactions. 

The  substances  employed  in  the  treatment  of  ordinary  discolorations 
are  conveniently  grouped  into 

a.  Agents  that  furnish  free  chlorine,  or  indirect  oxidizers. 

b.  Agents  that  furnish  nascent  oxygen,  or  oxidizing  agents. 

c.  Agents  that  have  an  affinity  for  oxygen,  or  reducing  agents. 
For  the  removal  of  metallic  stains,  additional  agents,  chiefly  in  the 

nature  of  solvents,  are  required.  Wliile  the  use  of  chlorine  to  secure  a 
change  of  the  metallic  deposit  to  a  chloride,  followed  by  thorough  wash- 
ing with  warm  distilled  water,  is  held  to  be  the  general  rule  of  treatment, 
its  final  success  may  depend  upon  the  solubility  of  the  chloride.  Chlo- 
rides are  commonly  soluble  in  water,  but  silver  chloride  is  an  excep- 
tion, it  being  entirely  insoluble.  Hence,  in  removing  silver  stains  the 
chlorine  treatment  is  followed  by  a  saturated  solution  of  sodium  thiosul- 
(150) 


BLEACHING  AGENTS  151 

phate  (hyposulphite),  which  is  a  solvent  for  chloride  of  silver.  In  remov- 
ing stains  of  manganese  the  final  washing  must  be  with  a  solution 
containing  oxalic  acid.  In  case  of  mercurial  stain,  Kirk  advises  the 
use  of  an  aqueous  ammoniacal  solution  of  hydrogen  dioxide  after  the 
chlorine  treatment. 

CHLORINE  GROUP. 

Chlorine.  The  value  of  chlorine  gas  as  a  bleacher  depends  largely  upon 
its  aflBnity  for  hydrogen,  by  which  it  may  either  directly  break  up  the 
color  molecule  or  liberate  oxygen  from  the  water  molecule.  In  the 
former  case  it  is  a  direct  decolorizer,  and  in  the  latter  it  is  indirectly  an 
oxidizer.  The  gas  is  now  seldom  applied  directly  to  the  tooth,  although 
the  Wright  method  employed  it  this  way  with  good  results,  but  the 
complicated  apparatus  needed  prevented  its  general  adoption.  At  the 
present  time  it  is  applied  either  in  solution  or  in  a  loosely  combined 
preparation  which  yields  it  up  readily. 

The  official  preparations  yielding  chlorine  in  sufficient  strength  to  be 
of  any  value  in  bleaching  are  the  following: 

Liquor  Sodae  Chlorinatae.  Solution  of  Chlorinated  Soda.  Labar- 
raque's  Solution.  This  liquid  contains  at  least  2.4  per  cent,  of  available 
chlorine. 

Calx  Chlorinata.  Chlorinated  Lime.  This  is  a  whitish  powder  con- 
taining at  least  30  per  cent,  of  available  chlorine.  The  powder  dete- 
riorates upon  exposure  to  the  air,  becoming  moist  and  losing  its  strong 
odor  of  chlorine.  If  kept  in  metal  containers  it  is  unfit  for  bleaching 
teeth,  because  of  the  liability  of  metallic  contamination.  It  is  preferably 
kept  in  paraffined  card-board  packages  or  in  bottles.  To  be  fit  for  use 
it  must  be  dry  and  should  exhale  a  strong  odor  of  chlorine. 

When  either  chlorinated  lime  or  Labarraque's  solution  of  chlorinated 
soda  is  employed,  it  is,  after  being  placed  in  the  tooth,  treated  with  any 
dilute  acid,  usually  50  per  cent,  of  either  acetic  acid  or  tartaric  acid,  in 
order  to  free  the  chlorine  more  rapidly.  The  use  of  chlorinated  lime  in 
this  way  constituted  the  original  Truman  method  of  bleaching  teeth. 

The  incompatibilities  with  chlorine  are  stated  in  the  chapter  on 
Antiseptics. 

OXYGEN  GROUP. 

Hydrogen  Dioxide.  This  substance  and  its  properties  are  discussed 
fully  in  the  chapter  on  Antiseptics.    ^^Hiile  the  official  3  per  cent,  solution 


152  LOCAL   REMEDIES 

possesses  some  degree  of  bleaching  power,  its  use  has  been  largely  super- 
seded bv  that  of  the  "caustic  p^Tozone"  or  25  per  cent,  ethereal  solution. 
Its  value  depends  upon  the  nascent  ox^-gen  "v\"hich  it  liberates.  Kirk* 
states  that  "more  rapid  and  permanent  effects  are  produced  when  the 
p^Tozone  solution  is  rendered  alkaline,"  which  may  be  done  by  the  addi- 
tion of  a  httle  of  one  of  the  solutions  of  the  pure  alkalies,  either  aqua 
ammonise  fortior  or  solution  of  potassium  or  sodium  hydroxide.  Special 
care  must  be  taken  in  handling  and  using  the  25  per  cent,  solution,  on 
account  of  its  caustic  action  upon  the  fingers,  which  may  be  prevented 
by  first  oiling  them. 

This  agent  is  also  employed  by  cataphoresis,  for  which  purpose  an 
aqueous  solution  must  be  prepared  from  the  25  per  cent,  ethereal  solu- 
tion^ as  the  latter  presents  too  great  resistance  to  the  current.  This  is 
accomplished  by  mixing  two  volumes  of  the  25  per  cent,  ethereal  solution 
with  one  volume  of  water  and  heating  gently  until  the  ether  is  evap- 
orated. Care  must  be  taken  to  prevent  ignition  of  the  ether  vapor.  The 
3  per  cent,  aqueous  solution  may  also  be  concentrated  by  careful  heating 
at  60°  C.  a-iO°  F.). 

Sodium  Dioxide.  Sodiu:m  Peroxide  [Xa202]  (not  official).  Occurs 
as  a  yellowish-white  powder  that  absorbs  water  readily  when  exposed  to 
the  air,  with  deterioration  of  its  activity.  It  is  caustic,  soluble  in  water, 
and  strono:lv  alkaline.     Its  valtie  as  a  bleacher  is  threefold: 

First,  it  liberates  nascent  oxygen  as  does  hydrogen  peroxide,  but  after 
parting  with  one  of  its  atoms  of  ox;\-gen  it  still  possesses  caustic  and 
alkaline  properties.     (Kirk.) 

Second,  it  possesses  some  solvent  power  upon  albuminous  matter. 

Third,  it  has  the  power  of  saponif\-ing  fats. 

Thus  it  not  only  acts  as  an  oxidizer,  but  as  a  detergent. 

It  is  applied  in  saturated  aqueous  solution,  which  must  be  prepared 
at  a  low  temperature  in  order  to  avoid  loss  of  strength.  If  weaker  solu- 
tions are  desired  in  some  cases,  they  may  be  prepared  from  the  saturated 
solution  by  diluting  carefully  with  water. 

Benzoyl-acetyl  Peroxide.  Acetozoxe.  Benzozone  [C^li-COOOCOCIi^ 
fnot  ofiicial).  In  a  comparative  experimental  study  of  bleachersf  Dr. 
Hoff  has  obtained  results  that  wotdd  seem  to  place  this  new  agent  next 
to  hydrogen  dioxide  and  sodium  dioxide.  He  describes  it  as  an  organic 
peroxide,  whose  decomposition  products  are  not  destructive  to  the  tooth 

*  American  Text-book  of  Operative  Dentistry. 
t  Dental  Cosmos,  February,  1902. 


BLEACHING  AGENTS  163 

structure.  It  acts  slowly,  and  it  may  be  allowed  to  remain  for  some  time 
within  the  cavity. 

This  drug  is  obtainable  in  form  of  a  whitish  powder,  consisting  of 
equal  parts  of  the  pure  crystal  and  an  inert  powder,  which  makes  a  cloudy 
solution  in  water.  The  solubility  of  the  crystals  in  water  varies  from 
1 :1000  to  1 :10,000.  It  is  slightly  soluble  in  alcohol  and  in  ether.  Nearly 
all  solvents,  including  water  and  alcohol,  decompose  it  gradually.  It 
should  be  kept  in  small,  well-stoppered  bottles  in  a  cool  place,  securely 
protected  from  moisture,  and  from  contact  with  organic  matter,  alkalies, 
alcohol  and  other  solvents. 

In  aqueous  solution  this  drug  is  claimed  to  be  a  very  powerful,  non- 
toxic germicide. 

Potassium  Permanganate  parts  readily  with  its  oxygen  when  brought 
into  contact  with  organic  matter.  Its  disadvantage  as  a  bleaching 
agent  is,  that  the  resulting  compounds  are  dark-colored  and  require 
to  be  treated  with  a  solution  of  oxalic  acid  in  order  to  complete  the 
decolorization. 

REDUCING  AGENTS. 

Sulphur  Dioxide  [SOj]  (not  official).    A  gas. 

Acidum  Sulphurosum.  Sulphurous  Acid.  An  aqueous  solution  con- 
taining not  less  than  6  per  cent.,  by  weight,  of  sulphur  dioxide  gas. 

Both  are  bleaching  agents  by  reason  of  their  affinity  for  oxygen. 
However,  they  do  not  destroy  organic  pigments,  as  the  color  may  be 
largely  restored  by  an  alkali  or  a  stronger  acid,  according  to  Witthaus. 
The  dioxide  (SOg)  possesses  the  stronger  affinity,  being  oxidized  in  the 
presence  of  water  to  sulphurous  acid  (SO3H2),  and  finally  to  sulphuric 
acid  (SO4II2).  The  dioxide  gas  being  preferable,  Kirk  advocates  the 
use  of  a  mixture  of  10  parts  of  sodium  sulphite  and  7  parts  of  boric  acid, 
which,  being  packed  into  a  tooth  and  moistened  with  water,  may  be 
quickly  sealed  in  with  a  temporary  filling.  A  reaction  occurs  between 
the  two  substances  with  liberation  of  sulphur  dioxide.  The  bleaching 
process  by  this  method  is  slower  than  by  the  use  of  the  peroxides. 

The  solution  in  water  known  as  sulphurous  acid  is  less  efficient  than 
the  gas,  but  still  may  be  employed.  It  must  be  remembered  that  the 
final  product  of  oxidation  of  this  class  of  bleachers  is  sulphuric  acid, 
which  must  be  thoroughly  removed  or  neutralized. 

Incompatibility.  Sulphurous  acid  gas,  or  its  solution,  is  incompatible 
with  acids,  with  ferric,  mercuric,  and  silver  salts,  with  carbonates  and 
with  solutions  of  iodine. 


154  LOCAL  REMEDIES 

Sodii  BisulpMs.     Bisulphite  of  Sodium  [NaHSOs]. 

Sodii  Sulphis.     Sulphite  of  Sodium  fNa2S03  +  7H20]. 

These  salts  are  freely  soluble  in  water,  and  when  exposed  to  air  lose 
sulphur  dioxide.  They  are  of  use  as  sources  of  sulphur  dioxide  gas 
when  they  are  decomposed.  In  bleaching  of  teeth  the  sulphite  chiefly 
is  used,  as  in  the  process  noted  above.     (See  also  under  Antiseptics.) 

Sodii  Thiosulphas.  Hyposulphite  of  Sodium  [Na2S203  +  5H20]. 
This  salt,  soluble  in  0.35  part  of  water,  is  used  in  saturated  solution  to 
remove  the  silver  chloride  resulting  from  previous  treatment  of  silver 
stains  with  chlorine. 


CHAPTER   XIII. 

ANESTHETICS.    LOCAL  ANALGESICS. 

ANESTHETICS. 

AxESTHETics  are  agents  used  to  abolish  sensibility,  for  the  purposes 
of  surgical  treatment,  the  relief  of  spasm,  and  the  alleviation  of  severe 
pain.  Complete  cjene/al  anesthesia  includes  unconsciousness,  due  to 
paralysis  of  the  cerebral  cortex,  and  loss  of  excitability  of  all  centres  of 
reflex  action,  except  those  concerned  in  the  functions  of  respiration  and 
circulation.  Local  anesthesia  means  usually  the  abolition  of  sensibility 
to  pain  in  a  certain  locality.  It  is  rather  a  condition  of  analgesia,  which 
is  defined  to  be  the  absence  of  sensibility  to  pain,  as  distinguished  from 
anesthesia,  which  means  the  absence  of  all  sensibility. 

When  confronted  by  the  necessity  of  a  surgical  operation,  a  decision 
must  be  made  first  as  to  the  advisability  of  using  an  anesthetic,  then, 
as  to  whether  local  or  general  anesthesia  shall  be  employed,  and  finally 
the  choice  of  the  agent  must  depend  upon  the  condition  of  the  patient, 
the  length  of  time  required  for  the  operation  and  the  comparative  safety 
of  the  drugs  from  which  a  selection  is  to  be  made. 

In  major  operations  the  necessity  of  general  anesthesia  appears  at 
once,  and  the  chief  point  will  be  the  choice  of  the  drug  to  be  used.  In 
minor  operations,  such  as  the  extraction  of  a  tooth  or  the  lancing  of  an 
abscess,  we  should  not  resort  too  readily  to  general  anesthesia.  We 
should  rather  allow  the  patient  to  assume  the  responsibility  of  deciding 
to  take  an  anesthetic.  And  in  case  of  a  prolonged  or  severe  operation  in 
dental  practice,  the  patient's  physician  should,  as  a  rule,  assume  the 
responsibility  of  deciding  what  anesthetic  shall  be  used,  and  also  super- 
vise its  administration.  The  use  of  local  analgesics  may  be  more  readily 
resorted  to  for  any  minor  operation  about  the  mouth. 

LOCAL  ANALGESICS. 

These  agents  are  employed  to  paralyze  the  sensory  nerve  endings  to 
painful  impressions  in  a  limited  region.  They  produce  their  effects  in 
two  ways,  and  are  accordingly  classified  into : 

(155) 


156  LOCAL  REMEDIES 

Refrigerant  Analgesics,  or  those  which  cause  an  abstraction  of  heat 
from  the  part,  even  to  tlie  point  of  freezing  the  tissue,  and 

Paralyzant  Analgesics,  or  those  which  have  a  specific  paralyzant  action 
upon  the  sensory  nerve  terminals.     The  refrigerant  class  comprises: 
Ice  and  salt  mixture. 
Rhigolene  spray, 
Ether  spray. 
Chloride  of  ethyl  spray. 

The  value  of  all  of  these  depends  upon  the  operation  of  the  physical 
law  that  a  solid  in  changing  to  a  liquid,  or  a  liquid  changing  to  a  vapor, 
requires  a  certain  amount  of  heat  to  effect  the  change.  The  heat  so  required 
becomes  latent  in  the  new  form  of  the  substance  and  is  necessary  to  the 
maintenance  of  that  form. 

When  a  mixture  of  ice  and  salt  is  applied  to  tissue,  heat  is  abstracted 
so  rapidly  by  the  melting  ice  that  the  part  may  be  frozen  superficially. 
The  only  use  of  the  salt  in  the  mixture  is,  by  its  affinity  for  water,  to 
make  the  ice  melt  more  rapidly.  It  would  be  impossible  to  freeze  tissue 
by  the  application  of  ice  alone,  because  of  the  slow  abstraction  of  heat. 
One  danger  in  the  application  of  ice  and  salt  is  freezing  too  intensely  or 
too  extensively,  which  may  induce  sloughing  of  tissue.  The  more  salt 
there  is  added  to  the  ice  up  to  a  certain  point  the  more  rapidly  will  freez- 
ing occur.  Therefore,  to  a  given  quantity  of  ice,  pounded  fine,  one-fourth 
to  one-third  as  much  salt  should  be  added.  They  should  be  well  mixed 
and  applied  in  such  manner  that  heat  may  be  abstracted  only  from  the 
part  to  be  operated  upon. 

This  mixture,  probably  the  earliest  of  all  local  analgesics,  must  still  be 
accorded  a  place  of  usefulness,  although  it  has  been  largely  superseded 
by  the  highly  volatile  liquids  whose  effects  are  so  easily  secured  and 
controlled.  It  may  be  used  upon  an  accessible  surface,  but  within  the 
mouth  it  is  certainly  inferior  to  a  spray. 

The  liquids  used  for  local  analgesic  purposes  must  be  very  volatile  at 
or  below  the  temperature  of  the  body,  so  as  to  evaporate  rapidly  when 
sprayed  upon  the  tissues.    The  following  have  been  employed: 

.ffither  (Ethylic).  Boils  at  about  95°  F.  It  is  very  inflammable,  the 
vapor  forming  an  explosive  mixture  with  the  air. 

Rhigolene  (not  official),  a  distillate  of  petroleum,  boiling  at  65°  F. 
It  may  be  explosive  under  certain  conditions. 

.ffithylis  Chloridum.  Ethyl  Chloride.  Boils  at  55°  F.  As  a  liquid 
it  burns  with  a  smoky  flame;  and  its  vapor  is  very  inflammable,  but 
probably  not  explosive. 


LOCAL  ANALGESICS  157 

The  comparison  of  boiling  points  and  inflammability  of  the  above 
agents  indicates  the  superiority  of  ethyl  chloride,  which  is  practically  the 
only  one  used  at  present. 

Chemically,  ethyl  chloride  [C2H5CI]  is  an  ester    resulting  from  the 

action  of  hydrochloric  acid  gas  upon  absolute  alcohol.     It  is  a  colorless 

liquid,  inflammable  and  extremely  volatile,  with  a  specific  gravity  at 

46.4°  F.  of  0.918.    The  specific  gravity  of  its  vapor  is  2.22.     It  is  put 

up  for  use  in  sealed  tubes  containing  2^  or  1  fluidounce.    By  means  of  a 

capillary  opening  through  the  glass  stopper  a  very  minute  jet  is  emitted, 

which  is  directed  upon  the  part  to  be  frozen.    Thus  there  is  no  waste, 

and  the  fine  stream  may  be  forced  a  distance  of  a  foot  or  more,  especially 

if  the  pressure  within  the  tube  be  increased  by  enclosing  it  in  the  warm 

hand.    The  action  of  the  drug  is,  therefore,  easily  controlled  and  may 

be  secured  at  any  point  within  the  mouth  without  endangering  the 

tissues. 

Fig.  2 


Chloride  of  ethyl  spray  tube. 

Some  pain  attends  the  freezing  of  tissue  by  whatever  means  induced, 
but  this  disadvantage  is  outweighed  by  the  assurance  the  patient 
acquires  that  the  pain  of  the  operation  will  be  much  lessened. 

Indeed,  for  the  extraction  of  a  tooth,  the  mental  effect  of  the  harmless 
chloride  of  ethyl  application  may  be  taken  advantage  of  to  nerve  a 
hesitating  or  nervous  person  up  to  a  point  of  ready  co-operation.  With 
this  agent  a  number  of  teeth  may  be  extracted  at  one  sitting  with  prac- 
tically no  danger;  moreover,  by  inhalation  the  drug  has  been  found  to 
be  a  quick  and  powerful  general  anesthetic,  whose  safety  seems  to  be 
equal  to  that  of  ether;  so  there  is  very  little  danger  from  any  inhalation 
of  the  drug  attending  its  local  use.  The  full  efi^ect  of  the  application 
is  shown  by  blanching  of  the  tissues  at  the  point  of  evaporation.  The 
action  being  chiefly  upon  the  gums,  the  real  advantage  to  be  sought 
is  painless  application  of  the  forceps.  We  cannot  expect  the  actual  pain 
of  extraction  to  be  entirely  removed. 


158  LOCAL  BEMEDIES 

On  the  whole,  the  use  of  this  substance  is  to  be  highly  recommended. 
Its  convenience,  readiness,  safety  and  comparative  efficacy  give  it  a  sum 
of  advantages  not  possessed  by  any  other  local  analgesic  for  slight  opera- 
tions.    As  a  general  anesthetic  it  is  considered  in  Chapter  XIV. 

The  'paralyzant  class  of  local  analgesics  includes  the  following  drugs, 
which  are  here  compared  as  to  solubility,  their  other  properties  and 
uses  being  discussed  in  regular  order.     Only  the  first  is  official. 

Cocaine  Hydrochloride,  soluble  in  0.4  part  of  water,  2.6  parts  of  alcohol. 
Eucaine  Hydrochloride  (Beta),*  soluble  in  30  parts  of  water.     (See  p. 
169.) 

Tropacocaine  Hydrochloride,  soluble  in  water.     (See  p.  169.) 
Holocaine  Hydrochloride,  readily  soluble  in  boiling  water,  which  upon 
cooling  leaves  a  2^  per  cent,  solution.     (See  p.  169.) 
Nirvanin,  easily  soluble  in  water.     (See  p.  169.  ) 
Stovaine,  easily  soluble  in  water  and  in  alcohol.     (See  p.  170.) 
Alypin,  soluble  in  water  and  in  alcohol.     (See  p.  170.) 
Novocaine,  soluble  in  1  part  of  water,  30  parts  of  alcohol.    (See  p.  170.) 
Orthoform,  slightly  soluble  in  water,  freely  in  alcohol.     (See  p.  170.) 
These  all  obtund  or  paralyze  the  sensory  nerve  terminals  wherever 
they  are  applied,  affecting  chiefly  sensibility  to  pain.     They  produce 
very  little  effect  upon  the  unbroken  skin.     Upon  mucous  membrane, 
whose  texture  is  less  firm,  their  effect  is  decided,  but  their  full  action  is 
only  obtained  when  they  are  applied  to  a  denuded  surface  or  injected 
h^-podermically ;  except,  that  in  the  application  to  the  very  sensitive 
mucous  membrane  of  the  eye  a  complete  effect  is  quickly  obtained, 
although  no   abrasion   be  present. 
Three  dangers  are  recognized  as  pertaining  to  the  use  of  these  drugs: 

1.  Damage  to  the  tissues  treated,  leading  at  times  to  sloughing. 

2.  General  poisoning. 

3.  Formation  of  habit. 

Cocainse  Hydrochloridum  [C17H21NO4HCI]  stands  as  the  typical  and 
chief  agent  of  this  class.  It  is  a  neutral  salt  of  the  alkaloid  cocaine,  from 
the  leaves  of  Erythroxyloii  coca  and  other  varieties  of  coca,  grown  chiefly 
in  Peru  and  Bolivia.  ^"Miile  the  alkaloid  was  discovered  about  1860, 
and  its  peculiar  analgesic  power  obser^^ed  soon  after,  its  introduction 
to  the  medical  world  as  a  practical  local  analgesic  was  due  to  Karl  Koller, 
who  in  1884  reported  experiments  to  the  Congress  of  German  Oculists. 
In  a  few  weeks  cocaine  was  being  used  all  over  the  world. f 

*  Alpha-eucaine,  being  more  irritating,  is  now  seldom  used, 
y  Park's  History  of  ]\Iedicine, 


PLATE    II. 


COCA. 

The  leaves  of  Erythrosylon  Coca 
or  E.  Truxillense. 

The  alkaloid  Cocaine  fully  rep- 
resents the  drug. 

[For  preparations  and  doses,  see 
Index  of  Drugs.] 

Classified  as  : 
Cei'ebral  stimulant. 
Mydriatic. 
Local  analgesic. 
General  protoplasmic  poison. 

Physiologic  action:  Sensory 

The    drug   pro-   nerve  endings 

1  r     .  1       depressed — — 

duces   liist    a    de-      ,^     , 

.  when  locauy 

scendmg  stimula-  applied. 
tion  of  the  central 
nervous  system,  followed  by 
a  descending  depression  if  a 
large  dose  has  been  taken. 
The  succession  may  be  irreg- 
ular, so  that  a  case  of  cocaine 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


poisoning    may  show  mixed  Voluniarxj 
symptoms  of  stimulation  and 
depression. 

The  two  diagrams  presented  (Plates  II.  and  III.)  show  the 
stimulant  and  depressant  effects  respectively. 
Stomach.     The  local  effect  is  to  benumb  the  sensory  nerve  endings 
in  the  stomach. 

Nervous  Si/stem. 

Bi'ain.     Stimulates  the  cerebral  cortex. 
Medulla.     Stimulates  respii'atory  and  vasomotor  centres. 
Spinal  cord.     Stimulates  reflex  centres. 
Sensory  nerve  endings  are  always  depressed  when  the 
drug  is  applied  locally. 
Muscular  System.     Increases  irritability  and  working   power  of 

voluntary  muscles. 
Eye.     Dilates  pupil  by  stimulating  dilator  nerves. 
Circulation.     Arterial  pressure  is  increased. 
Heart.     Action  accelerated  by  direct  stimulation  either  of 

heart  muscle  or  of  the  accelerator  nerves. 
Capillary  area.      Contracts  arterioles  by  stimulation   of 
vasomotor  centre  in  the  medulla  and  by  direct  action  upon 
the  vessel  walls. 

Respiration.     Eate  increased  by  stimulation  of  respiratory  centre. 
Elimination.     Cocaine  has  been  detected  in  the  urine,  but  its  in- 
fluence upon  the  kidneys  is  variable  and  uncertain,  therefore 
probably  indirect. 


Solar  Plexus 


The  red  color  indicates 
the  stimulant  eflfects 
of  Cocaine. 


LOCAL  ANALGESICS  159 

Administered  internally,  the  coca  leaves  and  their  preparations,  as 
well  as  the  alkaloid,  are  stimulating  to  the  nervous  system  in  small  doses 
and  depressing  and  poisonous  in  large  doses. 

Locally  applied  to  sensory  nerves,  cocaine  is  always  depressing. 
Applied  to  the  tongue  it  removes  the  sense  of  taste  for  bitter  substances, 
diminishes  it  for  sweet  and  acid  substances,  while  for  salt  it  is  not 
appreciably  lessened.  When  taken  into  the  stomach  it  diminishes  the 
sensibility  of  the  organ,  and  thereby  lessens  the  sense  of  hunger,  and 
probably  impairs  the  activity  of  digestion.  The  sense  of  touch  may  be 
lessened  by  it,  but  the  most  marked  result  of  its  application,  and  the 
most  desirable,  is  the  removal  of  the  sense  of  pain.  The  temperature 
sense  for  heat  and  cold  is  not  diminished.  It  usually  is  applied  as 
directly  as  possible  to  the  terminal  endings  of  the  sensory  nerve,  but 
will  produce  the  same  effect  if  applied  to  the  nerve  trunk  anywhere  in 
its  course.*  It  should  be  noted  that  cocaine  has  a  deleterious  effect  upon 
all  kinds  of  tissue  when  applied  in  any  but  very  small  quantities ;  there- 
fore it  is  classed  as  a  general  protoplasmic  poison.  The  reason  for  the 
prominence  of  its  effect  upon  nerve  tissue  is,  that  we  are  here  dealing 
with  the  tissue  that  is  a  medium  of  sensation  and  expression,  and  its 
impairment  is,  therefore,  more  easily  appreciated.  Being  one  of  the 
drugs  that  combines  a  stimulant  (early)  effect  with  a  depressant  (later) 
effect,  the  greatest  degree  of  caution  must  be  exercised  to  avoid  the 
habitual  use  of  the  drug  by  patients.  It  is  one  of  the  most  seductive 
of  the  drugs  that  are  taken  habitually,  and  its  effects  are  most  disastrous. 
Particularly  is  it  unwise  to  order  this  drug  for  the  patient  to  use  at  home, 
whether  as  gargle,  mouth  wash,  or  nasal  spray. 

Observation  has  shown  that  the  system  acquires  a  tolerance  of  large 
doses  of  cocaine  when  it  is  taken  habitually,  as  is  the  case  with  morphine, 
the  quantity  taken  daily  in  some  cases  reaching  as  high  as  30  grains. 
The  drug  is  often  taken  as  a  substitute  for  morphine,  or  as  an  antagonist 
to  it.  The  effects  of  cocaine  taken  habitually  seems  to  be  more  rapidly 
disastrous  than  those  of  morphine. 

*  We  are  indebted  to  Dr.  G.  W.  Crile  for  some  facts  concerning  the  value  of  cocaine 
in  blocking  nen-e  trunks  to  the  transmission  of  sensory  impressions  from  an  injured 
part  of  the  body.  By  very  careful  experiments  he  has  come  to  the  conckision  that 
one  prominent  factor  in  surgical  shock  is  the  depression  of  the  vasomotor  system 
by  exhaustion  of  the  centres.  This  occurs  through  their  excessive  stimulation  by 
sensory  impressions  coming  from  the  site  of  injury  or  operation.  In  operations  upon 
the  extremities,  he  prevents  shock  by  "nerve-blocking"  with  cocaine,  i.  e.,  by  inject- 
ing the  drug  about  the  nerve  trunk  so  as  to  abolish  its  power  of  carrying  sensory 
impressions. 


160  LOCAL   REMEDIES 

In  the  practical  use  of  the  drug  the  hydrochloride  of  cocaine  is  preferred 
to  the  simple  alkaloid,  because  of  its  greater  solubility.  Alkaloids,  as  a 
rule,  are  only  sparingly  soluble  in  water,  hence  their  salts  are  commonly 
employed.  Cocaine  illustrates  this  rule,  being  only  soluble  in  600  parts 
of  water,  while  the  hydrochloride  is  soluble  in  0.4  part  of  water.  It  is 
also  soluble  in  2.6  parts  of  alcohol. 

It  is  obtained  in  form  of  crystals  or  a  crystalline  powder,  permanent 
in  the  air  and  bitter  to  the  taste,  leaving  a  sensation  of  numbness  upon 
the  tongue. 

Solutions  of  cocaine  hydrochloride  do  not  keep  well  beyond  a  few 
days,  neither  can  they  be  sterilized  by  boiling  without  impairing  their 
value.  The  practitioner  must  either  make  up  his  solution  w^hen  needed, 
renew  it  frequently,  or  else  add  some  antiseptic  to  preserve  it.  If  it  is 
desired  to  keep  the  solution  more  than  a  few  days  a  very  little  carbolic 
acid  may  be  added.  One  per  cent,  of  this  should  prevent  the  growi;h 
of  organisms,  and  in  this  strength  the  coagulant  action  of  the  drug  is 
scarcely  noticed.  Boric  acid  likewise  is  used  as  a  preservative  in  the 
proportion  of  2h  per  cent,  to  the  aqueous  solution  of  cocaine.  Salicylic 
acid  is  also  recommended  in  the  strength  of  0.1  per  cent.  (1:1000). 
Chloretone  is  used  by  some  in  the  strength  of  J  to  ^  per  cent. 

Local  Action  of  Cocaine.  The  chief  interest  of  the  dental  surgeon  in 
this  drug  centres  about  its  use  as  applied  locally  to,  or  injected  beneath, 
the  mucous  membrane.  AYhen  applied  to  the  membrane  of  the  mouth 
the  bitterness  of  the  drug  is  marked.  The  pure  crystal  or  a  strong 
solution,  5  to  10  per  cent.,  will  cause  some  anemia  of  the  surface,  which 
is  probably  due  to  a  constrictor  action  upon  the  arterioles,  and  at  the 
same  time  the  sensitiveness  of  the  tissues  to  pain  will  be  abolished  to 
the  depth  of  penetration  by  the  drug.  For  surface  treatment,  or  upon 
so  sensitive  a  mucous  membrane  as  that  of  the  eye,  direct  application 
of  cocaine  in  1  to  4  per  cent,  solution  is  sufficient;  but  for  extraction  of 
teeth  such  application  is  of  no  use.  The  drug  must  be  injected  into  the 
tissues  about  the  socket  of  the  tooth.  When  this  is  done  there  occurs 
immediately  a  blanching  of  the  tissues  at  the  site  of  injection,  which 
is  due  partly  to  forcible  distention  by  the  fluid  injected,  and  probably 
partly  to  vascular  constriction.  Some  pain  attends  the  use  of  the  drug 
in  this  way,  but  it  occurs  only  at  the  moment  of  injection,  and  is  quickly 
succeeded  by  complete  analgesia  of  the  locality.  The  vasoconstriction 
is  often  follow^ed  by  a  relaxation  that  permits  hyperemia  of  the  tissues, 
which  may  be  more  or  less  painful.  This,  however,  must  be  regarded  as  a 
secondary  and  later  effect,  occurring  rather  after  than  during  the  operation. 


PLATE    III. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


Solar  Plexus 


COCAINE. 

The  poisonous  effects  of  Coca, 
or  the  secondaiy  effects  of  a  large 
dose,  are  depressant,  following 
quite  definitely  the  lines  of  pre- 
vious stimulation. 


Nervous  System. 

Brain.  Cerebral  functions  are 
depressed,  frequently  with 
production  of  narcosis  or 
convulsions. 

Medulla.  Depi-esses  respira- 
tory center  and  probably 
vaso-motor  center. 

Spinal  cord.  Depresses  re- 
flex centers. 

Circulation.     Arterial  pressure  is 
lessened. 
Heart.     Depressed  by  direct 

action  of  the  drug. 
Capillary  area.    Arterioles 
relaxed,    probably    through 
paralysis  of  vasomotor   cen- 
ter. 

Respiration.  Depresses  the  respi- 
ratory functions  by  lessening 
the  irritability  of  the  center 
in  the  medulla. 


In  general,  the  depressant  ac- 
tion is  that  of  a  general  proto- 
plasmic poison,  the  commonest 
evidence  of  which  is  its  pai-al- 
yzant  influence  upon  nei-ve  tissue 
when  locally  applied. 


For  local  analgesic  purposes  the 
alkaloid  Cocaine  is  employed  in 
from  J  to  4  per  cent,  solutions. 


The  blue  color  indicates  the  depressant  eflfects  of  a  toxic 
dose  of  Cocaine. 


LOCAL  ANALGESICS  161 

Dosage.  The  strength  of  cocaine  solutions  employed  varies  from 
I  to  4  per  cent.,  according  to  the  rapidity  and  degree  of  effect  desired, 
the  total  quantity  used  being  limited  by  considerations  of  safety.  The 
maximum  quantity  allowed  to  gain  entrance  into  the  circulation  at  one 
time  should  not  exceed  one-quarter  of  a  grain.  This  ought  to  be  the 
limit  in  the  ordinary  use  of  the  drug  by  hypodermic  injection.  However, 
the  free  bleeding  of  the  tissues  following  extraction  will  remove  some  of 
the  drug,  and  may  modify  our  estimate  of  the  quantity  that  may  be  safely 
injected  in  a  given  case.  A  2  per  cent,  solution  will  usually  suffice,  and 
of  this  twelve  and  one-half  minims  contain  one-quarter  of  a  grain. 
When  application  is  made  to  the  surface  of  the  mucous  membrane  of 
the  mouth,  or  when  the  drug  is  used  by  cataphoresis,  stronger  solutions 
may  be  required ;  and  when  the  drug  is  so  applied  that  absorption  occurs 
only  through  the  unbroken  mucous  membrane,  a  larger  quantity  may 
be  used,  but  should  never  exceed  one-half  of  a  grain,  which  is  the 
maximum  dose  for  stom.ach  administration.  For  direct  application  to 
the  pulp  of  a  tooth,  a  small  quantity  of  a  stronger  solution  or  a  little 
of  the  pure  crystal  may  be  employed. 

An  excellent  rule  in  the  interest  of  exactness  of  dose  and  ease  of 
calculation  is  given  by  Burchard.*  It  is  "to  make  the  solution  upon 
the  basis  of  8  grains  of  the  cocaine  salt  to  1  ounce  of  the  menstruum, 
which  will  give  1  grain  in  each  drachm  and  -^^^  of  a  grain  in  each 
minim."  This  solution  would  be  a  little  less  than  2  per  cent,  in  strength. 
Ten  minims  would  equal  |  of  a  grain,  which  would  be  within  the  safe 
hypodermic  dose  for  an  adult. 

That  this  drug  is  one  of  the  most  dangerous  of  those  in  daily  use  is 
attested  by  the  many  cases  of  cocaine  poisoning  that  are  upon  record. 
Among  those  well  authenticated  is  the  case  of  a  girl,  eleven  years  of  age, 
whose  death  resulted  in  forty  seconds  from  the  hypodermic  injection 
of  12  drops  of  a  4  per  cent,  solution,  or  about  ^  grain. f  In  another 
case  death  is  said  to  have  been  caused  by  the  application  of  20  drops 
of  a  5  per  cent,  solution  (1  grain)  to  the  gum.| 

Among  other  cases  of  severe  poisoning  by  cocaine,  without  a  fatal 
result,  the  following  are  noted  :§ 

T.  H.  Burchard  reports  a  case  in  which  10  drops  of  a  4  per  cent, 
solution  hypodermically  caused  unconsciousness  and  apparent  death  in 
four  minutes;  Meyerhausen,  a  case  in  which  8  drops  of  a  2  per  cent. 

*  American  Text-book  of  Operative  Dentistry,  second  edition,  page  641. 
t  Wood's  Therapeutics,  eleventh  edition,  page  201. 

t  Ibid.  I  Ibid. 

11 


162  LOCAL    REMEDIES 

solution  upon  the  conjunctiva  of  a  girl  of  twelve  years  produced  violent 
symptoms;  Stevens,  one  in  which  4  minims  of  a  3^^  per  cent,  solution 
caused,  in  a  man,  violent  convulsions  followed  by  mania;  Frost,  a  case 
of  a  child  of  fourteen  in  which  1  drop  of  a  1  per  cent,  solution  in  the 
eye  caused  marked  poisoning. 

We  cannot  avoid  the  impression  that  idiosyncrasy  must  account  for 
the  occurrence  of  such  cases,  but  the  fact  that  they  are  not  rare  should 
lead  to  the  exercise  of  the  greatest  care  and  discrimination  in  the  employ- 
ment of  cocaine.  In  the  interest  of  safety  the  weaker  solutions  may  be 
employed  in  combination  with  other  drugs  that  aid  the  action  of  cocaine, 
to  which  later  reference  is  made. 

Schleich  Method.  Mention  should  also  be  made  of  a  modification 
known  as  the  Schleich  method.  This  consists  of  infiltration  of  the  tissues 
with  a  very  weak  solution  of  cocaine  by  a  series  of  contiguous  injections, 
which  produce  really  a  local  edema.  Three  different  strengths  of  cocaine, 
approximately  1 :  500,  1 :  1000  and  1 :  10,000,  are  employed  as  the  case 
demands.*  To  the  solution  is  added  0.2  per  cent,  of  sodium  chloride 
and  small  quantities  of  morphine  hydrochloride  and  phenol.  The 
1 :  1000  is  the  strength  commonly  used.  Undoubtedly  the  pressure 
of  distention  by  the  larger  bulk  of  solution  injected  contributes  to  the 
analgesia,  for  it  has  been  found  that  forcible  distention  of  tissues  by 
sterile  water  often  suffices  for  slight  operations.  While  this  method  will 
probably  never  be  extensively  used  in  dental  surgery,  it  has  the  advan- 
tage of  permitting  a  large  quantity  of  solution  to  be  used,  and  a  longer 
operation  to  be  performed  with  much  less  danger  of  cocaine  poisoning. 

A  number  of  ready-made  solutions  for  local  analgesia  are  upon  the 
market.  They  are  primarily  commercial  articles,  and  it  is  safe  to  say 
that  cocaine  usually  forms  the  basis  of  their  formulas.  There  is  no 
reason  why  a  qualified  practitioner  should  select  a  commercial  formula 
instead  of  making  up  his  own  solution,  when  using  so  powerful  a  drug. 

There  is  absolutely  no  guarantee  of  the  composition  and  uniformity 
of  the  proprietary  analgesic  preparations,  even  though  the  names  of 

*  The  precise  formulse  of  the  three  solutions  are  as  follows: 


parts. 

parts. 

parts. 

Cocaine  hydrochloride, 

0.2 

0.1 

0.01 

Morphine  hydrochloride, 

0.025 

0.025 

0.005 

Sodium  chloride, 

0.2 

0.2 

0.2 

Phenol  (5  per  cent.), 

0.30 

0.30 

0.30 

Distilled  water  (sterilized),  100.00  100.00  100.00 


LOCAL  ANALGESICS  163 

ingredients  are  given ;  while  if  the  practitioner  orders  by  his  own  formula 
of  official  drugs,  his  pharmacist  can  guarantee  accuracy. 

The  advantages  claimed  for  special  formulas  are:  first,  that  they 
contain  substances  that  aid  the  desired  action  and  permit  a  lessening 
of  the  quantity  of  cocaine  used;  second,  that  they  contain  one  or  more 
physiologic  antagonists  to  cocaine,  which  will  counteract  any  possible 
toxic  action;  or,  third,  that  they  keep  better  than  a  simple  solution  of 
cocaine.  All  of  these  objects  are  desirable,  but  it  is  better  for  the  dentist 
himself  to  intelligently  and  scientifically  select  his  own  aids  and  antag- 
onists to  the  drug.  This  implies  a  knowledge,  on  his  part,  of  the  physio- 
logic action  of  the  various  drugs  proposed,  and  the  ability  to  note  the 
indications  for  the  selection  of  one  or  another  in  a  given  case.  And  this 
is  not  too  much  to  expect  of  the  trained  practitioner  of  to-day. 

As  a  type  of  combination  that  will  be  found  generally  applicable,  the 
following  is  suggested: 


Gm.  o 

•  c.c. 

. — Cocainse  hydrochloridi, 

16 

(gr.  iiss) 

Atropinse  sulphatis, 

008 

(gr.  i) 

Strychninse  sulphatis, 

03 

(gr.  ss) 

Phenolis, 

12 

Kij) 

Aquae  destillatse,          q. ; 

i.  ad 

15 

(flss)-M. 

The  cocaine  strength  of  this  solution  will  be  1  per  cent.,  and  each 
15  minims  will  contain  ^  grain,  with  jhu  grain  of  atropine,  and  3I5- 
grain  of  strychnine.  One  or  two  drops  of  adrenalin  solution  (1 :  1000) 
may  be  added,  if  desired,  to  each  quantity  of  injection.  The  carbolic 
acid  present  in  0.8  per  cent,  is  for  preservation.  Even  less  will  suffice 
to  keep  the  solution  for  some  time. 

Prinz  *  suggests  that  the  solution  should  be  made  isotonic  with  the 
blood,  so  as  to  preserve  normal  cell  osmosis,  which  is  doubtless  an  ad- 
vantage in  the  matter  of  lessening  the  irritation  caused  by  the  solution. 
He  states  that  to  make  a  1  per  cent,  solution  of  cocaine  isotonic  requires 
the  addition  of  0.8  per  cent,  of  sodium  chloride,  making  the  following 
proportions : 

Cocaine  hydrochloride,  5  grains. 

Sodium  chloride,  4      " 

Sterile  water,  1  fluidounce. 

To  each  syringeful  (30  minims)  he  adds  2  drops  of  adrenalin  chloride 
solution  when  used. 

General  Action  of  Cocaine.     Plates  II.  and  HI.  are  intended  to  illus- 
trate the  action  of  the  drug  upon  the  different  parts  of  the  system. 
*  Dental  Cosmos,  September,  1908,  p.  931. 


164  LOCAL  REMEDIES 

Aids  to  the  Action  of  Cocaine.  Other  agents  of  the  same  class,  that 
are  less  poisonous  and  sufficiently  soluble,  may  supplant  cocaine  to  some 
extent.  Eucaine,  tropacocaine  and  carbolic  acid  may  be  combined  with 
cocaine  in  the  same  solution.  If  there  is  an  open  wound  or  denuded 
surface  orthoform  powder  is  useful.  Agents  that  lessen  the  blood  supply 
to  the  part,  as  cold  applications,  will  aid  slightly. 

The  use  of  adrenalin  as  an  aid  to  the  action  of  cocaine  is  growing  in 
favor.  The  claim  that  less  cocaine  is  needed  when  so  combined  seems 
to  be  borne  out  in  the  experience  of  surgeons.  Two  factors  in  its  action 
serve  to  explain  its  value:  first,  it  contracts  the  arterioles  locally,  thus 
lessening  the  amount  of  blood  in  the  injected  area;  and,  second,  it 
lessens  the  activity  of  absorption  into  the  circulation  beyond  the  locality. 

It  is  evident  that,  with  the  local  circulation  lessened  by  vasocon- 
striction, less  cocaine  is  likely  to  pass  into  the  circulation  in  a  given  time, 
which  means  that  more  remains  just  where  its  effect  is  wanted,  and  the 
danger  of  systemic  poisoning  is  slightly  lessened.  The  combination  is 
easily  made  by  adding,  to  the  solution  of  cocaine  hydrochloride  for 
each  injection,  several  drops  of  the  1 :  1000  adrenalin  chloride  solution. 
Reports  indicate  that  the  cocaine  strength  of  the  solution  can  be  con- 
siderably reduced.  One  series  of  100  operations,*  which  included 
resection  of  the  superior  maxilla,  removal  of  a  goitre  and  complete 
removal  of  the  larynx,  were  performed  under  the  use  of  a  solution 
consisting  of  9  parts  of  a  ^  per  cent,  solution  of  cocaine  and  1  part  of 
adrenalin  (1  :  1000). 

If  the  part  to  be  operated  upon  admits  of  a  ligature  being  placed 
about  it,  so  as  to  lessen  the  circulation  within  it,  the  entrance  of  the 
cocaine  into  the  general  circulation  will  be  limited  and  its  local  effect 
prolonged.  Morphine  has  little  or  no  local  analgesic  action,")"  therefore 
it  is  without  value  as  an  aid  to  cocaine. 

Antagonists  to  the  Action  of  Cocaine.  Poisoning  by  cocaine  may  be 
due  to: 

(a)  Idiosyncrasy,  rendering  the  patient  very  sensitive  to  its  action. 

Q))  A  weakened  state  of  vital  organs,  rendering  them  more  liable  to 
depression  by  the  drug. 

(c)  An  overdose.     (See  Plate  III.) 

The  most  serious  conditions  in  cocaine  poisoning  are  depression  of 
heart,  vasomotors  and  respiratory  centre.  The  combined  result  of  these 
is  to  lessen  the  arterial  pressure  very  decidedly,  with  a  certain  degree  of 

*  See  Gould's  Year  Book  of  Medicine  and  Surgery,  1905  (Medical  vol.),  p.  472. 
t  See  notes  on  page  85. 


LOCAL  ANALGESICS  165 

asphyxia  added.  These  are  the  conditions  to  be  antagonized.  There- 
fore, it  appears  at  once  that  any  agent  that  does  not  either  stimulate  the 
vasomotor  system,  the  heart,  or  the  respiratory  centre,  is  of  no  value. 
Nitrite  of  amyl  and  nitroglycerin  dilate  the  arterioles  by  depressing 
the  vasomotor  system ;  they  do  not  stimulate  respiration  and  their  direct 
action  upon  the  heart  is  doubtful.  Therefore,  they  should  never  be  used 
to  antagonize  cocaine,  chiefly  because  they  will  still  further  reduce  the 
arterial  pressure.*  Our  best  antagonists  will  be  those  that  increase 
arterial  pressure  by  stimulation  of  both  vasomotor  centres  and  heart, 
and  which  at  the  same  time  stimulate  the  respiratory  centre.  Three 
agents  that  act  in  all  three  ways  are  caffeine,  strychnine  and  atropine. 
Caffeine  has  a  dose  of  1  to  5  grains  (0.06-0.30  gm.)  and  is  soluble  in 
not  less  than  25  parts  of  water  ;t  therefore  it  would  be  an  impracticable 
substance  to  include  in  a  cocaine  solution.  The  dose  of  strychnine 
sulphate  is  -^-q  to  ^t  o^  ^  grain  (0.001-0.006  gm.)  and  of  atropine  sulphate 
TT^to  g-Vof  a  grain  (0.0005-0.001  gm.),  and  both  are  sufficiently  soluble 
so  that  they  may  be  combined  in  the  same  solution  with  cocaine.  The 
dose  for  injection  at  one  sitting  should  not  exceed  j  grain  of  cocaine 
hydrochloride,  y|-q  of  atropine  sulphate,  and  -J^  of  strychnine  sulphate; 
then  in  case  of  danger  symptoms  from  the  cocaine  the  other  drugs  may 
be  repeated  in  the  same  dose,  but  the  atropine  sulphate  not  more  than 
once.  It  is  well  to  have  at  hand  separate  hypodermic  tablets  of  these 
drugs  in  the  doses  mentioned,  not  for  routine  administration  in  every 
case,  but  for  use  according  to  the  operator's  judgment.  It  would  be 
unwise  to  depend  upon  these  in  order  to  exceed  the  safe  dose  of  cocaine, 
but  in  persons  known  to  be  susceptible  to  its  depressant  action,  or  where 
such  susceptibility  is  feared,  it  is  proper  to  employ  these  antagonists. 

*  Nitroglycerin  has  been  prominently  mentioned  as  an  antagonist  to  cocaine,  but 
if  it  is  of  value  in  any  case,  it  must  be  only  when  employed  with  discrimination.  If 
the  action  of  adrenalin  locally  is  an  advantage,  when  combined  with  cocaine,  then  the 
local  action  of  nitroglycerin  cannot  be,  for  they  are  exact  antagonists  in  influencing 
the  circulation  locally.  As  to  its  general  effect,  it  is  contraindicated  when  blood 
pressure  is  low.  In  poisoning  by  cocaine  it  would  be  of  no  value  if  reduction  of 
pressure  had  followed  the  early  slight  rise;  and  if  there  is  much  depression  of  the  cir- 
culation it  may  do  harm  by  further  reducing  blood  pressure.  It  is  doubtful  whether 
nitroglycerin  has  any  direct  stimulant  action  upon  the  heart.     (See  Plate  XIII.) 

f  Caffeine  in  its  simple  form  is  soluble  in  45.6  parts  of  water  and  53.2  parts  of 
alcohol  at  25°  C.  (77°  F.),  but  the  addition  of  benzoate  or  salicylate  of  sodium  renders 
it  very  soluble  in  water.  Caffeine-sodium  salicylate  and  caffeine-sodiimi  benzoate  each 
are  soluble  in  2  parts  of  water  and  may  be  used  hypodermically  in  dose  of  1  to  5 
grains  (0.06-0.30  gm.). 

Citrated  caffeine  forms  a  clear,  syrupy  liquid  with  about  4  parts  of  hot  water. 
Upon  dilution  with  water,  tliis  yields  a  white  precipitate  (caffeine),  which  redissolves 
when  about  25  parts  of  water  have  been  added. 


166  LOCAL  REMEBLES 

Acute  Poisoning.  The  poisonous  effects  of  cocaine  are  variable.  The 
drug  has  the  power  to  first  stimulate  and  later  depress  the  central  ner- 
vous system,  but  when  a  toxic  condition  suddenly  occurs  there  may  be  an 
irregularity  of  symptoms.     There  are  likely  to  occur,  however: 

(a)  Depression  of  the  brain,  manifested  by  narcosis  or  spasm. 

(6)  Depression  of  the  medulla  and  spinal  cord,  as  shown  by  failure 
of  respiration  and  depression  of  vasomotor  and  reflex  activity. 

(c)  Direct  depression  of  the  heart,  which,  with  lessened  vasomotor 
control,  causes  a  marked  fall  of  arterial  pressure. 

In  treating  the  condition,  we  must  rely  upon  the  remedies  mentioned 
above  for  the  purpose  of  stimulating  the  whole  central  nervous  system, 
in  order  to  induce  activity  of  cerebral  functions,  of  respiration,  and  of 
circulation.  Plate  IV.  illustrates  the  action  of  these  and  of  digitalis, 
which  also  is  indicated  if  the  circulatory  failure  is  at  all  persistent.  In 
this  emergency  f5i-l  (1-4  c.c.)  of  tincture  of  digitalis  may  be  given 
h}^odermically.  But  it  must  be  remembered  that  digitalis  is  a  slowly 
acting  drug  and  cannot  be  relied  upon  alone  for  sudden  emergencies. 

Adrenalin  is  among  the  most  useful  of  agents  for  stimulating  a 
depressed  circulation.  It  acts  both  by  direct  stimulation  of  the  heart 
and  by  constriction  of  arterioles,  causing  a  decided  rise  of  arterial  blood 
pressure.  The  disadvantage  of  uncertainty  of  action,  unless  employed 
intravenously,  lessens  its  practical  value  in  emergency  cases.  It  gives 
no  result  when  administered  by  the  stomach  and  very  little  when  injected 
hvpodermically  in  ordinary  quantities;  but  its  use  by  the  latter  method 
should  be  resorted  to  quite  freely  in  emergency.  One  to  5  c.c.  of  the 
1  :  1000  solution,  diluted  with  ten  times  as  much  normal  saline  solu- 
tion, may  be  injected. 

Immediate  stimulation  of  both  respiration  and  circulation  should  be 
secured  also  by  administering,  and  applying  to  the  air  passages,  some 
of  the  irritant  agents  that  stimulate  reflex  activity  by  irritating  sensory 
nerve  endings.  The  chief  preparations  that  act  in  this  way  are  water 
of  ammonia  and  spirit  of  camphor  by  inhalation ;  and  for  administration 
by  the  stomach,  aromatic  spirit  of  ammonia,  spirit  of  ammonia,  alcohol, 
spirit  or  compound  spirit  of  ether,  each  in  dose  of  15  to  60  minims 
diluted  with  twice  as  much  water,  and  whisky  and  brandy,  1  to  2  fluid- 
drachms  undiluted.  If  necessary,  repeat  the  dose  of  any  in  ten  or  fifteen 
minutes. 

The  fact  holds  that  these  agents  are  useful  mainly  by  reason  of  their 
irritant  action.  They  should,  therefore,  be  given  without  much  dilution, 
so  that  their  effect  upon  sensory  nerve-endings  in  the  mouth,  throat. 


LOCAL  ANALGESICS  167 

esophagus  and  stomach  may  be  decided,  and  the  consequent  reflex 
stimulation  of  the  heart  and  respiratory  center  be  efficient.  Irritation 
of  the  skin  by  friction,  slapping  or  faradism  will  act  in  the  same  way, 
but  less  efficiently  than  the  above  agents  applied  to  the  mucous  mem- 
brane. 

Fig.  3 


Sylvester's  method  of  artificial  respiration:  movement  of  inspiration. 

If  there  be  considerable  depression  of  the  respiration,  as  shown  by 
slow  or  weak  movements  of  the  chest  or  by  cyanosis,  artificial  respiration 
should  be  resorted  to  in  order  to  secure  proper  oxygenation  of  the  blood. 
In  connection  therewith  massage  of  the  heart  by  an  assistant,  by  pressure 

Fig.  4 


Sylvester's  method  of  artificial  respiration:  movement  of  expiration. 

between  diaphragm  and  chest  wall,  particularly  with  the  movement 
of  expiration,  has  come  to  be  employed  as  an  important  aid  in  re-estab- 
lishing the  heart's  efficiency.  It  is  most  effectual  in  cases  where  the 
irritability  of  the  heart  muscle  is  not  much  impaired. 

Sylvester's  method  of  artificial  respiration  is  the  one  most  commonly 
employed.     Figs.  3  and  4  show  the  position  of  patient  and  attendant. 


i68  LOCAL  REMEDIES 

The  movements  of  inspiration  and  expiration  should  succeed  each  othef 
regularly  at  the  rate  of  from  twenty  to  twenty-five  respirations  per 
minute,  or  once  in  about  three  seconds,* 

In  imitation  of  natural  respiration  the  inspiratory  period  should  be 
slightly  longer  than  the  expiratory.  AVhenever  artificial  respiration  is 
needed  in  any  kind  of  poisoning,  it  should  be  continued  until  natural 
respiration  is  established.  This  may  require  hours  of  work  by  a  relay 
of  assistants. 

The  Howard  method  of  artificial  respiration  also  is  convenient  and 
useful.  It  is  described  as  follows  :t  "  The  patient  is  turned  upon  his 
back,  and  a  bolster  of  clothing  or  of  other  material  is  placed  under  him 
so  as  to  throw  his  epigastrium  forward.  His  wrists  are  crossed  behind 
his  head  and  held  in  that  position.  His  tongue  is  drawn  forward  and 
held  with  a  dry  handkerchief  in  the  extreme  corner  of  his  mouth.  The 
operator  now  kneels  astride  the  patient's  hips,  'resting  the  ball  of  each 
thumb  upon  the  corresponding  costoxiphoid  ligaments,  the  fingers 
falling  naturally  into  the  lower  intercostal  spaces.  Resting  his  elbows 
against  his  sides  and  using  his  knees  as  a  pivot,  he  throws  his  whole 
weight  slowly  and  steadily  forward  until  his  mouth  nearly  touches  the 
mouth  of  the  patient,  and  while  he  might  slowly  count  one,  two,  three; 
then  suddenly,  by  a  final  push,  springs  himself  back  into  his  first  erect 
position  on  his  knees;  he  remains  there  while  he  might  slowly  count  one, 
tivo,  then  repeats,  and  so  on  about  eight  or  ten  times  in  a  minute.'  " 

The  Laborde  method  of  rhythmic  traction  upon  the  tongue  may  be 
used  as  a  stimulant  to  respiratory  movements  when  there  is  any  possi- 
bility of  response,  the  tongue  being  grasped  by  the  fingers  over  a  dry 
napkin,  or  by  a  tenaculum  or  forceps,  and  drawn  forcibly  forward  at 
intervals  of  about  four  seconds.  Laborde  holds  that  this  measure  excites 
reflexly  the  movements  of  the  diaphragm  especially. 

A  still  more  powerful  means  of  exciting  respiration  reflexly,  is  that 
of  rhythmically  stretching  the  sphincter  ani.  This  has  been  found  very 
useful  in  resuscitation  from  dangerous  anesthesia  and  from  opium 
poisoning. 

Incompatibility.  Cocaine  hydrochloride  is  incompatible  with  alkalies 
and  alkaline  carbonates,  with  tannic  acid,  and  with  some  metallic  salts. 
It  is  decomposed  by  potassium  permanganate.     With  solution  of  silver 

*  The  average  normal  rate  of  respiration  is  about  eighteen  per  minute,  but  as  the 
need  of  aeration  is  urgent,  and  as  artificial  respiration  is  apt  to  be  less  efficient  than 
the  normal  function,  it  is  well  to  exceed  the  normal  rate  slightly. 

■{•  Atkinson.     American  Text-book  of  Applied  Therapeutics,  1896,  p.  37. 


PLATE    V, 


Danger  area 


Anesthesia  area 

1.  Consciousness  abolished 


3,  Hespiration  paralysed 


4,  Circulation  paralysed         \  Heart 


2.  "Reflex  activity  abolished 


The  several  sections  are  numbered  in  the 
order  in  which  they  are  paralyzed  by  anes- 
thetics. The  paralysis  of  1  and  2  constitutes 
surgical  anesthesia,  paralysis  of  3  introduces 
an  element  of  great  danger,  and  that  of  4  is 
usually  fatal. 

[The  heart  is  included  in  this  diagram  of 
the  several  parts  of  the  central  nervous  sys- 
tem, for  the  reason  that  it  contains  nerve- 
ganglia,  which,  with  their  highly  irritable 
muscular  structure,  provides  for  its  auto- 
matic, rhythmic  action.  This  provision  is 
quite  independent  of  the  cerebrospinal  sys- 
tem.] 


LOCAL  ANALgJESICS  l6& 

nitrate  a  white  precipitate  of  chloride  of  silver  occurs.  A  white  pre- 
cipitate also  occurs  with  a  solution  of  borax  or  with  a  strong  solution 
of  fhenol.  According  to  Gorgas  it  reacts  chemically  with  mercurous 
chloride  and  with  mercuric  oxide.* 

Substitutes  for  Cocaine.  It  cannot  be  said  that  any  drug  has  yet  been 
found  that  is  equal  to  cocaine  when  we  consider  activity,  solubility  and 
reliability.  But  the  several  substitutes  named  in  the  cocaine  group 
deserve  mention,  with  a  statement  of  the  advantages  claimed  for  them 
and  the  disadvantages  attending  their  use.  Any  agent  of  this  group, 
in  order  to  be  entitled  to  consideration,  must  compare  favorably  with 
cocaine  not  only  as  to  efficiency,  but  in  addition  it  must  be  less  toxic, 
or  its  solutions  must  keep  better,  or  it  must  possess  some  other  decided 
advantage. 

EucAiNE  Hydrochloride.  Beta-eucaine  Hydrochloride  {C^^^^O^- 
HCl]  (not  official).  This  artificial  alkaloid  has  found  its  place  of 
usefulness  as  an  efficient  analgesic  and  it  is  less  toxic  than  cocaine. 
It  is  soluble  in  about  30  parts  of  water  and  its  solutions  not  only  keep 
well,  but  may  be  boiled  without  injury.  It  is  rated  as  about  one-fourth 
as  poisonous  as  cocaine,  but  it  is  more  irritating  and  its  combination 
with  adrenalin  is  less  efficient.  It  is  used  in  from  2  to  5  per  cent,  solu- 
tions for  direct  application  or  hypodermic  injection,  and  in  1  per  cent, 
strength  may  be  substituted  for  cocaine  in  the  Schleich  solutions  for  infil- 
tration anesthesia. 

Tropacocaine  Hydrochloride  (not  official).  Tropacocaine  is  an  al- 
kaloid obtained  from  the  leaves  of  Java  coca,  but  prepared  also  syn- 
thetically. While  less  toxic  than  cocaine,  twice  the  amount  is  needed 
to  produce  the  same  effect,  and  it  is  more  irritating,  but  its  solutions  are 
said  to  keep  better. 

Holocaine  Hydrochloride  (not  official).  This  drug  is  an  antiseptic, 
therefore  its  solutions  will  keep  indefinitely.  It  is  soluble  in  50  parts  of 
water.  (See  p.  158.)  While  it  is  claimed  that  its  action  is  more  powerful 
than  that  of  cocaine,  it  is  more  irritating  and  more  toxic.  Sudden  death 
has  occurred  during  its  use. 

Nirvanin  (not  official).  This  occurs  in  crystalline  or  powder  form, 
is  soluble  in  water  and  alcohol,  the  aqueous  solution  being  neutral,  and 
claimed  to  be  germicidal  in  1  per  cent,  strength.  It  is  used  in  from  1  to 
5  per  cent,  solutions.  It  is  reported  to  be  only  one-tenth  as  toxic  as  cocaine, 
and  in  efficiency  to  compare  quite  favorably  with  other  substitutes  for 

*  Dental  Medicine,  fifth  edition. 


170  LOCAL  REMEDIES 

that  drug.  As  it  is  too  early  to  give  accurate  conclusions  from  experience 
it  should  be  used,  if  at  all,  with  due  caution. 

Stovaine  (not  official).  The  solution  of  this  drug  is  acid.  It  is  less 
toxic  than  cocaine,  but  it  is  less  efficient  and  more  irritating. 

The  two  following  drugs  seem  to  possess  more  advantages  than  the 
above.  Novocaine  particularly  is  gaining  recognition  as  a  really  practi- 
cal and  efficient  substitute  for  cocaine. 

Alypiii  (not  official).  This  substance  presents  the  advantage  of  being 
nearly  as  efficient  as  cocaine,  while  scarcely  more  irritating,  and  it  is 
claimed  to  be  less  toxic.  It  is  used  in  solutions  of  from  2  to  10  per  cent. 
It  causes  some  hyperemia  when  applied  to  the  conjunctiva,  and  it  is 
stated  that  hemorrhage  following  its  use  is  not  so  easily  controlled  by 
adrenalin  as  after  cocaine. 

Novocaine  (not  official).  This  drug  is  soluble  in  1  part  of  water.  It 
is  non-irritating  and  causes  no  h}^eremia.  It  is  much  less  toxic,  though 
less  efficient  than  cocaine,  and  its  effect  is  more  transient.  Its  action  is 
increased  by  adrenalin. 

Prinz  *  regards  novocaine  as  the  only  one  of  these  substances  that 
meets  the  demands  of  substitution  for  cocaine.  He  cites  evidence  that 
its  combination  with  adrenalin  increases  the  efficiency  of  both  drugs 
in  their  local  action.  He  prefers  a  2  per  cent,  solution  and  suggests  the 
following: 

Novocaine,  10  grains 

Sodium  chloride,  4      " 

Distilled  water,  1  fluidounce. 

Boil.     To  each  syringeful  (30  minims)  add  2  drops  of  adrenalin  cliloride 
solution  when  used. 

Orthofonn  (not  official).  This  drug  is  inferior  to  cocaine  because  of 
slight  solubility  in  water,  but  fills  a  distinct  place  among  analgesics  on  ac- 
count of  that  fact.  It  is  useful  for  prolonged  effect  dusted  upon  ulcerated 
or  denuded  surfaces.  It  cannot  be  used  hypodermically  to  advantage, 
although  some  surgeons  have  reported  success  in  its  use  in  this  way, 
the  drug  being  suspended  in  water  for  injection.  It  is  freely  soluble  in 
alcohol  and  in  ether;  also  soluble  in  equal  parts  of  alcohol  and  water. 
In  powder  form  it  is  an  ideal  dressing  for  painful  burns;  and  it  may 
be  dissolved  in  collodion  for  local  use  upon  a  dried  surface  for  wounds 
resulting  from  injury  or  from  surgical  operations.  It  is  not  poisonous 
to  the  system  in  quantities  ordinarily  employed,  the  internal  dose  being 

*  Dental  Cosmos,  September,  1908,  p.  932. 


LOCAL  ANALGESICS  171 

from  1  to  15  grains  (0.06-1  gm.).  After  extraction  of  teeth  from  an 
inflamed  alveolar  process,  and  when  laceration  of  tissues  in  the  mouth 
has  been  unavoidable,  the  resulting  pain  and  soreness  may  be  largely 
relieved  by  the  application  of  orthoform  in  powder.  It  may  also  be 
packed  into  the  tooth  socket  with  good  effect  after  extraction. 

Incompatibility.  Orthoform  is  generally  used  alone.  It  is  incom- 
patible with  silver  nitrate,  potassium  permanganate  and  with  zinc 
chloride. 

Spinal  Cocainization.  Among  the  methods  of  inducing  analgesia, 
that  of  injecting  a  solution  of  cocaine  (0.2  to  0.5  per  cent,  strength)  into 
the  spinal  canal  has  been  employed,  having  been  first  advocated  by 
Dr.  Corning,  of  New  York.  By  this  means  all  parts  of  the  body  below 
the  point  of  injection  may  have  sensation  to  pain  abolished,  so  that 
it  is  possible  to  do  even  an  extensive  surgical  operation  by  aid  of  this 
method. 

There  are  dangers  attending  this  procedure,  and  its  limitations  will 
probably  soon  be  defined.  When  employed,  the  injection  should  be 
made  as  low  down  as  possible,  so  as  to  avoid  the  effect  of  the  drug  upon 
the  medulla.  The  method  for  the  present  should  be  used  only  in  those 
cases  where  a  general  anesthetic  is  contraindicated,  and  where  the  site 
of  injection  may  be  at  a  point  some  distance  from  the  medulla. 


PART  III. 

GENERAL  REMEDIES. 


CHAPTER  XIV. 

ANESTHETICS. 

A  TOPIC  of  so  great  importance  as  that  of  general  anesthesia  merits 
brief  historical  references  as  to  agents  employed  and  their  discoverers.* 
Ethylic  ether,  formerly  called  "sulphuric  ether,"  and,  still  earlier, 
"sweet  oil  of  vitriol,"  was  known  as  early  as  the  thirteenth  century,  but 
the  name  of  its  discoverer  is  unknown.  While  it  was  used  for  some 
medicinal  purposes  in  the  eighteenth  century  and  probably  earlier,  and 
although  its  intoxicating  and  narcotic  properties  had  been  discovered, 
it  was  not  employed  for  practical  anesthesia  until  1842.  During  several 
years  it  was  put  to  successful  practical  tests  by  Crawford  Long,  of 
Georgia,  by  Horace  Wells,  of  Vermont,  and  by  William  T.  G.  Morton, 
of  Boston,  the  last-named  having  demonstrated  its  use  in  a  public  way 
in  Dr.  Warren's  clinic  at  the  Massachusetts  General  Hospital,  October 
16,  1846. 

With  the  discovery  of  chloroform  four  names  must  be  associated: 
Guthrie,  of  Sackett's  Harbor,  N.  Y.,  who  is  credited  with  its  first  dis- 
covery (1831);  Liebig,  of  Germany,  and  Soubeiran,  of  France,  who  were 
close  contemporaries  with  Guthrie  in  its  recognition,  and  Dumas,  who 
made  known  its  composition  in  1835  and  gave  it  its  present  name.  In 
1847  it  was  introduced  as  an  anesthetic  by  Simpson,  of  Great  Britain, 
a  physician  of  great  prominence,  who  at  once  began  to  use  it  extensively 
in  his  practice. 

Nitrous  oxide  gas  also  was  known  for  many  years  before  it  came  to  . 
be  practically  applied  as  an  anesthetic.     In  1799  Humphry  Davy,  of 
England,  observed  the  exhilarating  and  intoxicating  effects  caused  by 
inhaling  this  gas,  and  published  his  investigations  in  1800.    The  credit 

*  For  a  fuller  discussion  of  the  history  of  anesthesia,  see  Park's  Epitome  of  the 
History  of  Medicine. 

(173) 


174  GENERAL  REMEDIES 

for  its  first  use  as  a  surgical  anesthetic  belongs  to  Horace  Wells,  who 
employed  it  in  1844  for  the  extraction  of  a  tooth. 

The  condition  of  general  anesthesia  must  include  more  than  the 
abolition  of  consciousness  to  pain,  the  removal  of  unconscious  muscular 
activity  being  only  secondary  in  importance.  In  many  cases  a  compara- 
tively small  amount  of  an  anesthetic  will  suffice  to  abolish  consciousness 
of  pain,  but  muscular  rigidity  or  activity  will  prevent  the  performance  of 
a  surgical  operation.  The  term  partial  anesthesia  is  sometimes  applied  to 
a  grade  of  effect  where  the  cerebrum  is  paralyzed,  with  loss  of  conscioiis 
sensation,  but  where  the  reflex  centres  of  the  spinal  cord  are  still  sensitive, 
as  shown  by  muscular  activity  whenever  sensory  nerves  are  irritated. 

The  typical  anesthetics  are  peculiar  in  respect  to  the  order  in  which 
they  paralyze  the  different  parts  of  the  nervous  system.  At  first  thought 
the  production  of  complete  paralysis  of  all  parts  of  the  body  capable  of 
responding  to  external  stimuli,  by  the  administration  of  a  substance 
foreign  to  the  body,  would  seem  to  be  an  extremely  dangerous  pro- 
cedure; and  so  it  appeared  until  it  was  ascertained  that  the  paralysis 
was  induced  in  such  order  that  the  centres  of  consciousness  were 
affected  first  and  those  whose  activity  is  absolutely  essential  to  life  last. 
Any  agent,  therefore,  to  rank  safely  among  this  class  of  drugs  must 
conform  in  action  strictly  to  the  lines  of  safety  which  have  now  become 
well  established.  Plate  V.  presents  a  division  of  the  central  nervous 
system  into  sections,  which  are  numbered  in  the  order  in  which  they  are 
paralyzed  by  anesthetics.  It  will  be  seen  that  the  most  highly  developed, 
or  differentiated,  nerve  tissue  (brain)  is  first  affected,  while  the  simpler 
and  more  vital  structures  that  are  common  to  all  forms  of  animal 
existence  (those  connected  with  the  functions  of  respiration  and  circu- 
lation) are  affected  later,  being  apparently  more  resistant  to  the  influence 
of  the  drugs  of  this  class. 

Mode  of  Induction  of  Anesthesia.  Various  theories  have  from  time 
to  time  been  proposed  to  explain  the  mode  of  action  of  anesthetics, 
by  ascribing  their  effects  to  action  upon  the  blood,  to  alteration  of  the 
circulation  within  the  brain,  and  to  asphyxia;  but  all  theories  have 
yielded  to  a  positive  belief  that  these  substances  produce  their  effects 
chiefly  by  a  direct  action  upon  the  nerve  centres.  These  theories  have, 
however,  emphasized  certain  factors  which  often  contribute  to  the 
result  and  which  may  also  be  elements  of  danger.  Thus,  local  anemia 
in  the  brain  will  undoubtedly  facilitate  anesthesia,  but  if  that  anemia 
be  due  to  arterial  disease,  the  dangers  of  the  condition  may  contra- 
indicate  the  use  of  certain  agents.     Again,  and  more  important,  the 


ANESTHETICS  175 

factor  of  asphyxia  is  present  with  anesthesia  in  the  majority  of  cases 
where  an  agent  is  employed  with  a  hmited  supply  of  air.  This 
is  particularly  true  when  either  nitrous  oxide  or  ether  is  used.  It 
must  be  remembered  that  whatever  abolishes  brain  function  tends 
toward  unconsciousness,  whether  it  be  injury,  anemia,  drug  action,  or 
want  of  oxygen;  and  whenever  the  inhalation  of  an  anesthetic  is  con- 
ducted by  a  method  that  greatly  reduces  the  amount  of  air,  the  factor 
of  asphyxia  must  necessarily  be  present  in  some  degree.  This  obser- 
vation might  be  taken  as  an  argument  in  favor  of  chloroform,  which  is 
given  so  largely  diluted  with  air,  but  the  answer  must  be  that  there  are 
greater  dangers  than  asphyxiation;  and  chloroform  is  a  drug  whose 
depressant  action  upon  vital  structures  greatly  exceeds  in  its  danger 
that  of  moderate  asphyxia. 

As  to  the  precise  action  of  the  anesthetic  upon  nerve  cells,  it  has 
been  observed  that  the  volatile  liquid  anesthetics  are  fat  solvents;  and 
the  investigations  of  Meyer  and  Overton  led  them,  independently,  to 
the  conclusion  that  anesthesia  is  caused  by  the  solution  of  the  fatty 
constituents  of  the  cells  by  the  absorbed  anesthetic  vapor.  The  fact 
of  the  transient  influence  accords  with  a  belief  in  some  such  simple 
physical  change  as  solution,  which  would  obtain  only  while  the  vapor 
was  present  in  suflBcient  quantity.  Nitrous  oxide  may  need  to  be 
excluded  from  this  explanation;  and  while  it  is  probably  true  that  all 
anesthetics  do  not  act  in  the  same  way,  there  can  be  little  question  as 
to  the  fact  of  their  central  action. 

The  direct  action  of  the  drug  upon  nerve  centres  then  constitutes  the 
essential  point  in  anesthesia  production.  Equally  does  it  furnish  the 
index  as  to  danger  or  safety  in  the  course  of  its  inhalation.  Plate  V. 
will  aid  us  in  appreciating  the  stages  through  which  the  action  of  anes- 
thetics may  extend,  the  numbers  1  and  2  pertaining  to  essential  and 
safe  anesthesia,  and  3  and  4  to  the  dangers  of  profound  anesthesia. 

Stages  of  Anesthesia.  Descriptions  of  the  stages  of  anesthesia  are 
sometimes  so  elaborate  as  to  be  confusing.  The  simple  division  of 
Cushny  into  three  stages  seems  sufficient  for  ether  and  chloroform  at  least. 

A.  Imperfect  Consciousness.*  At  the  beginning  the  inhalation  may 
be  accompanied  by  a  sense  of  suffocation,  which  is  greater  with  ether 
than  with  chloroform  and  is  seldom  present  with  nitrous  oxide. 

*  This  stage  is  described  by  some  authorities  as  the  stimulant  stage,  but  the  stimu- 
lant effects  noted  are  mainly  reflex,  while  the  real  condition  is  one  of  depressed 
consciousness.  There  is  frequently  noticed  quite  early  a  very  brief  period  of  com- 
plete relaxation,  during  which  a  slight  operation  might  be  performed. 


176  GENERAL   REMEDIES 

The  cerebrum  is  very  quickly  affected,  with  the  production  of  various 
manifestations  of  disturbed  or  uncoijtrolled  nerve  function,  such  as 
incoherent  talking,  laughing  or  crying,  indefinite  muscular  movements 
and  holding  of  the  breath.  The  pulse  is  not  much  influenced  as  a  rule. 
Respiration  is  quite  normal  except  for  the  influence  of  the  early  choking 
sensation. 

The  pupils  are  responsive  to  light  and  are  apt  to  be  dilated.  The 
special  senses  are  disturbed.     Coughing  is  occasionally  present. 

B.  Excitement.  With  consciousness  completely  abolished,  the  control 
of  the  lower  part  of  the  cerebrospinal  system  by  the  cerebrum  is  removed, 
and  we  see  accordingly  various  manifestations  of  uncontrolled  reflex 
activity.  The  centres  here  concerned  are  mostly  situated  in  the  spinal 
cord,  which  is  the  second  division  of  the  nervous  system  to  be  influenced 
by  anesthetics.  (See  Plate  V.)  Being  not  yet  depressed  to  any  marked 
degree,  the  impulses  that  it  originates  without  cerebral  control  may 
produce  the  most  violent  muscular  action,  which  is  likely  to  be  most 
marked  shortly  before  complete  relaxation  occurs. 

This  stage  of  excitement  is  more  decided  when  ether  is  used,  than  with 
chloroform.  The  pulse  is  not  much  influenced  except  in  point  of  arterial 
pressure,  which  is  reduced,  especially  so  by  chloroform.  Respiration 
may  be  interrupted  by  rigidity  of  the  respiratory  muscles.  The  pupils 
are  apt  to  be  dilated  during  excitement.  They  are  responsive  to  light  as 
long  as  reflex  irritability  persists. 

Increased  secretion  of  tears,  and  of  mucus  in  the  upper  respiratory 
and  oral  regions,  occurs.  Vomiting  occurs  as  a  very  unpleasant  com- 
plication if  the  stomach  contains  any  food,  especially  when  ether  is 
employed. 

During  this  stage  conscious  sensation  of  pain  is  abolished,  but,  as  a 
rule,  surgical  procedure  is  impracticable  until  complete  relaxation  occurs, 
with  cessation  of  reflex  excitement,  which  marks  the  beginning  of 
complete  anesthesia.  Relaxation  is  generally  accompanied  by  snoring 
inspirations  due  to  vibration  of  the  relaxed  soft  palate. 

C.  Anesthesia.  With  the  occurrence  of  complete  anesthesia  the  whole 
muscular  system  is  relaxed  sleep  is  profound,  reflex  activity  is  absent; 
in  fact,  there  is  temporary  total  paralysis  of  nervous  and  muscular  sys- 
tems, except  those  parts  concerned  with  respiration  and  circulation. 
The  pulse  is  not  much  altered  in  rate,  but  blood  pressure  is  somewhat 
lessened.  Respiration  is  full  and  as  regular  as  during  profound  sleep. 
The  pupils  are  contracted  and  do  not  respond  to  light.  The  cornea  is 
insensible  to  touch.    The  general  appearance  does  not  differ  much  from 


ANESTHETICS  I77 

that  of  a  person  in  a  deep  sleep.  However,  with  ether  the  face  is  apt  to 
be  more  flushed  than  with  chloroform.  With  nitrous  oxide  given  alone 
some  degree  of  cyanosis  occurs. 

The  Important  Things  to  Watch  during  the  administration  of  an  anes- 
thetic may  be  grouped  as  below: 

First,  as  indicating  the  progress  and  degree  of  anesthesia: 

(a)  The  activity  of  the  reflexes. 

(b)  The  degree  of  muscular  resistance. 

(c)  The  condition  of  the  pupil  of  the  eye. 

As  shown  in  Plate  V.,  reflex  activity  persists  after  consciousness  is 
lost,  but  disappears  with  surgical  anesthesia.  Therefore,  as  long  as  any 
response  to  irritation  of  a  highly  sensitive  area  occurs,  and  as  long  as 
any  muscular  rigidity  exists,  we  cannot  say  that  the  proper  degree  of 
anesthesia  has  been  reached.  The  usual  way  of  testing  reflex  irritability 
is  by  touching  the  cornea  or  conjunctiva  of  the  eye  with  the  finger,  which 
should  be  clean.  The  reflexes  of  the  eye  being  among  the  last  to  dis- 
appear, any  response  by  a  closing  movement  of  the  eyelids  shows  that 
irritability  of  reflex  centres  still  persists,  while  absence  of  any  response 
usually  indicates  that  anesthesia  is  complete. 

Muscular  resistance  is  usually  tested  by  raising  the  patient's  arm  to 
full  length  perpendicularly  and  allowing  it  to  fall.  Any  slowness  or  inter- 
ruption in  its  fall  shows  muscular  response  and  indicates  that  anesthesia 
is  not  complete,  while  a  sudden  drop  of  the  arm,  as  if  paralyzed,  shows 
complete  muscular  relaxation  and  indicates  that  anesthesia  to  a  surgical 
degree  has  been  secured. 

Muscular  resistance  often  persists  after  ordinary  reflex  response  is 
lost.  This  is  of  special  importance  in  dental  operations,  where  it  is  fre- 
quently found  that  the  jaws  are  rigidly  closed  when  anesthesia  seems 
complete.  In  such  cases  it  is  necessary  to  push  the  effect  beyond  the 
degree  which  might  suffice  for  an  operation  upon  an  accessible  surface, 
in  order  to  secure  relaxation  of  the  jaws,  unless  a  mouth-gag  or  a  cork 
be  used  to  keep  the  jaws  apart  during  the  whole  period  of  inhalation. 

Again,  owing  to  the  necessity  of  suspending  inhalation  of  the  anes- 
thetic during  the  dental  operation,  as  for  extraction,  it  is  advisable  to 
push  the  administration  to  a  profound  degree,  so  that  the  effect  may  last 
during  the  brief  operation.  This  is  permissible  with  the  safer  anes- 
thetics, which  do  not  endanger  the  heart's  action.  It  may  be  stated, 
however,  that  an  operation  may  be  completed  even  after  reflex  activity 
is  again  evident,  provided  that  muscular  resistance  does  not  prevent, 
for  if  consciousness  be  still  abolished  the  patient  cannot  interpret  the 

12 


178  GEXEBAL   REMEDIES 

surgical  irritation  as  pain,  and  will  remember  nothing  of  the  opera- 
tion, even  though  some  struggling  may  have  occurred  through  reflex 
activity. 

The  pupils  remain  responsive  to  light  so  long  as  anesthesia  is  not 
complete,  with  a  tendency  to  dilatation  during  the  early  stages,  due  to 
the  excitement  that  is  more  or  less  evident.  AYith  complete  anesthesia 
the  pupils  contract  and  become  fixed,  i.  e.,  they  do  not  respond  to  light, 
and  appear  in  all  respects  as  they  do  during  profound  sleep.  After 
complete  anesthesia  has  been  induced,  dilatation  of  the  pupil  may  mean 
either  slight  return  of  reflex  acti^dty,  which  will  be  accompanied  by  the 
eye  reflex  and  may  call  for  more  anesthetic,  or  it  may  mean  a  paralysis, 
which  indicates  a  most  serious  depression  of  the  nervous  system  that 
may  be  speedily  fatal.  The  latter  will  be  unaccompanied  by  any  sign 
of  reflex  activity  or  of  muscular  resistance,  but  relaxation  will  be  com- 
plete. 

Second,  as  indicating  danger,  note  should  be  taken  of: 
(a)  The  respiration. 

(6)    The  pulse  (with  chloroform  especially). 
(c)    The  pupil. 

It  must  be  insisted  upon  that  the  respiration  be  watched  closely 
throughout,  for  it  has  been  shown  that  death  by  anesthetics  is  due, 
in  the  majority  of  cases,  to  failure  of  respiration  centrally,  by  paralysis 
of  the  respiratory  centres  in  the  medulla.  Early  in  the  administration, 
respiration  may  be  interrupted  by  the  chokuig  sensations  experienced 
by  the  patient,  and  after  consciousness  is  lost  there  is  usually  some 
stoppage  due  to  reflex  influences;  with  ether  this  may  be  so  marked  as 
to  cause  a  considerable  degree  of  cyanosis. 

These  interruptions  are  temporary,  and  as  long  as  the  pupils  are 
responsive  they  need  not  occasion  any  alarm,  for  any  stoppage  of 
respiration  before  anesthesia  is  complete  is  not  dangerous,  except,  that 
mechanical  closure  of  the  glottis  by  falling  back  of  the  tongue  might 
occasion  a  continued  stoppage,  resulting  in  fatal  asphyxia.  This  cause 
will  be  removed  by  dra^^ing  the  tongue  forward  by  forceps  or  a  silk 
ligature  passed  through  it,  or  by  either  of  two  simple  procedures  that 
are  usually  successful — ^turning  the  head  to  one  side  so  as  to  allow  the 
tongue  to  fall  to  the  side,  and  drawing  forcibly  forward  both  angles  of 
the  lower  jaw. 

AYhenever  interruption  of  respiration  has  occurred  reflexly  or  mechan- 
ically, the  first  succeeding  inspiration  is  apt  to  be  deep  and  forcible. 
With  chloroform  especially,  care  must  be  taken  not  to  allow  free  access 


ANESTHETICS  179 

of  the  drug  with  this  deep  inspiration,  for  fear  of  suddenly  poisoning 
the  heart  by  too  much  or  too  concentrated  vapor. 

During  complete  anesthesia  respiration  is  slow  and  regular  as  in 
normal  sleep.  It  is  most  important  to  watch  the  respiration  at  this  time. 
Any  irregularity  or  interruption  is  a  danger  sign,  and  must  require  sus- 
pension of  the  inhalation,  free  access  of  air,  and  respiratory  stimulants. 
If  cessation  has  occurred,  artificial  respiration  must  be  resorted  to  at 
once.  To  begin  with,  these  measures  may  be  instituted  without  regard 
to  the  pulse,  for,  with  respiration  paralyzed,  the  pulse  may  still  be  feebly 
perceptible,  or  the  heart  may  be  beating  so  feebly  as  to  cause  no  pulse 
in  the  peripheral  vessels.  In  either  case  the  rapid  elimination  of  the  drug 
by  exhalation,  and  the  free  supply  of  oxygen  by  inhalation,  are  most 
urgently  required. 

The  pulse  tells  us  of  the  rapidity  and  rhythm  of  the  heart's  action  and 
of  the  condition  of  arterial  pressure.  It  may  be  felt  at  the  wrist,  but  is 
very  conveniently  felt  by  the  anesthetist  at  the  temporal  artery.  Any 
excessive  rapidity  (say  above  120  per  minute)  and,  even  more  important, 
any  irregularity  or  marked  weakness  of  the  pulse  beats  should  enlist 
attention.  Rapidity  and  irregularity  are  necessarily  due  to  conditions 
in  the  heart  or  its  regulating  mechanism,  while  weakness  of  the  pulse 
may  be  due  in  part  to  low  blood  pressure  from  relaxation  of  the  arterioles. 
Stimulation  of  the  circulation  during  anesthesia  requires  those  agents 
that  will  maintain  arterial  pressure,  and  forbids  the  use  of  vasodilators 
which  lower  arterial  pressure.  The  recumbent  posture  with  head  low 
must  be  maintained  when  the  pulse  is  weak  or  irregular.  With  ether, 
the  pulse  seldom  shows  any  danger  symptoms,  but  remains  quite  normal 
throughout,  except  that  in  prolonged  anesthesia  arterial  pressure  is 
lessened.  With  chloroform,  the  direct  depressant  action  of  the  drug  upon 
the  heart  and  vasomotor  system  is  added  to  the  general  depression  of 
anesthesia,  and  there  is  accordingly  a  weaker  pulse,  lowered  arterial 
pressure,  and  less  ability  to  regain  the  normal  in  case  danger  symptoms 
occur. 

A  sudden  failure  of  the  heart,  even  early,  is  sometimes  observed  with 
the  administration  of  chloroform.  This  may  be  due  either  to  cardiac 
disease  which  permits  the  organ  to  be  easily  overcome,  or  to  too  rapid 
or  too  concentrated  inhalation  of  the  vapor.  The  necessity  impresses 
itself  of  watching  the  pulse  carefully  throughout  the  administration  of. 
chloroform. 

The  Pupils.  The  danger  symptom  that  may  be  presented  by  the 
pupils  occurs  only  during  profound  anesthesia,  and  consists  of  dilata- 


180  GENERAL  REMEDIES 

tion.  This  may  represent  stimulation  of  the  dilator  centre  due  to 
asphyxia,*  but  it  has  also  been  taken  to  mean  a  paralysis  of  the  contractor 
fibres.  It  is  possible  that  in  different  cases  both  explanations  may  find 
application.  Paralysis  would,  of  course,  be  regarded  as  the  more  serious 
condition.  During  profound  anesthesia  the  pupil  should  be  observed 
very  jrequently,  and  any  dilatation  not  accompanied  by  response  of 
reflexes  should  require  suspension  of  the  anesthetic  and  immediate 
attention  to  the  patient's  condition. 

Recovery  from  Anesthesia  varies  in  time  from  a  very  few  minutes  after 
nitrous  oxide  and  chloride  of  ethyl,  to  a  number  of  hours  after  ether. 
The  patient  often  passes  through  a  stage  of  excitement  similar  to  that 
preceding  anesthesia,  but  as  a  rule  less  pronounced.  Vomiting  almost 
invariably  occurs  w^hen  much  ether  or  chloroform  has  been  used.  After 
these  drugs  there  is  also  a  tendency  to  sleep,  and  normal  consciousness 
may  not  be  restored  for  several  hours. 

Contraindications  to  Anesthetics.  In  general,  we  may  say  that  serious 
disease  of  brain,  lungs,  heart,  bloodvessels  or  kidneys  contraindicates 
general  anesthetics.  But  a  general  rule  admits  of  many  exceptions,  and, 
therefore,  with  respect  to  this  matter  each  case  must  be  judged  by  itself. 
As  to  contraindications  to  indi^'idual  agents  more  definite  statements  can 
be  made. 

For  Nitrous  Oxide.  It  is  usually  held  that  serious  heart  or  lung 
affections,  that  will  easily  lead  to  embarrassment  of  respiration  or  circu- 
lation when  the  asphyxia  accompanying  the  use  of  nitrous  oxide  is  added, 
should  prohibit  the  use  of  this  gas ;  also  that  disease  of  the  arterial  walls 
to  the  point  of  weakening  them,  presents  the  danger  of  rupture  under 
nitrous  oxide.  This  statement  is  based  upon  the  belief  that  the  element 
of  asphyxia  leads  to  contraction  of  arterioles,  with  increased  blood 
pressure  in  the  smaller  arteries.  Apoplexy,  from  arterial  ruptiu-e  within 
the  brain,  would  be  the  most  serious  result  to  be  feared.  These  contra- 
indications may  be  largely  removed  by  the  combined  administration  of 
oxygen  with  the  nitrous  oxide. 

For  Chloroform.  In  addition  to  the  general  statement  above,  we 
should  note  that  disease  of  the  heart  muscle  (myocarditis,  myocardial 
degeneration  or  fatty  degeneration)  prohibits  the  use  of  chloroform.  As 
this  drug  is  capable  of  causing  fatty  degeneration  of  various  organs,  the 
structure  of  all  circulatory  and  eliminative  organs  should  be  normal  in 
order  to  admit  of  its  use.    Valvular  disease  of  the  heart,- if  well  compen- 

*  Sollmann,  Text-book  of  Pharmacology,  1901,  p.  441. 


Anesthetics  l8l 

sated,  IS  less  a  contraindication  than  is  degeneration  of  the  heart  muscle 
as  indicated  by  weakness,  irregularity  or  dilatation. 

For  Ether.  Whatever  contraindications  apply  to  chloroform  will  apply 
with  less  force  to  ether,  with  the  added  qualification  that  ether  has  very 
little  depressant  action  upon  the  heart.  On  account  of  the  comparatively 
large  amount  of  ether  required,  it  is  believed  by  some  to  be  particularly 
damaging  to  the  eliminative  organs,  especially  the  lungs  and  kidneys,  but 
it  is  probable  that  the  effects  here  are  less  permanent  and  less  serious 
than  those  produced  by  chloroform.* 

While  we  should  always  give  due  place  in  our  judgment  to  the  general 
contraindications  previously  stated,  when  any  anesthetic  is  in  question, 
yet,  when  we  have  mentioned  the  unpleasantness  of  ether  inhalation,  the 
excitement  that  it  frequently  causes,  and  the  prolonged  and  uncomfort- 
able period  of  recovery,  we  have  made  our  chief  complaints  against 
ether.  It  stands  first  as  a  safe  general  anesthetic  for  profound  and  pro- 
longed effect. 

Autointoxication  and  Asphyxia.  One  danger  of  anesthesia  that  has 
not  been  sufficiently  recognized  is  that  of  autointoxication.  Asphyxia 
is  an  important  factor  in  causing  this  condition,  as  by  the  deficiency  of 
oxygen  the  normal  elaboration  and  final  oxidation  of  tissue  elements  is 
interfered  with ;  consequently  elimination  is  deficient  and  waste  products 
accumulate  in  the  tissues.  The  result  will  be  interference  with  function, 
and  possibly  degeneration.  Cases  of  death  occurring  several  days  after 
the  use  of  ether  or  chloroform,  the  immediate  effect  of  the  drug  having 
been  recovered  from,  are  probably  due  more  to  autointoxication  than  to 
the  particular  anesthetic  employed. 

It  is  true  that  nitrous  oxide  anesthesia,  as  usually  employed,  is  so 
brief  that  the  asphyxia  that  necessarily  attends  it  because  of  the  closed 
inhaler  used,  may  be  disregarded  as  of  light  importance;  but  its  pro- 
longed use  should  be  accompanied  by  inhalations  of  pure  oxygen.  It 
may  be  too  early  to  insist  upon  the  use  of  oxygen  as  routine  practice 
in  connection  with  anesthesia  of  moderate  duration,  but  it  is  certainly 
advisable  in  greatly  prolonged  anesthesia  with  any  agent.  Objection 
must  be  made  to  inhalers  for  ether,  ethyl  chloride,  or  chloroform  that  do 
not  admit  enough  air  for  proper  oxygenation  of  the  blood. 

Preparation  of  Patient  for  Anesthesia.  For  ordinary  nitrous  oxide 
anesthesia  it  is  only  necessary  to  be  assured  of  the  non-existence  of 

*  See  conclusions  of  Committee  of  the  British  Medical  Association,  Lancet, 
London,  1901,  vol.  i.  p.  280. 


182  GENERAL  REMEDIES 

serious  disease  in  vital  organs  and  in  the  arterial  walls,  and  to  observe 
the  general  precautions  to  be  given  later.  For  prolonged  use  of  the  same 
agent,  similar  preparation  should  be  made  as  for  ether  and  chloro- 
form. 

Before  employing  either  of  these,  preparation  should  be  made  in  order 
to  avoid  unpleasant  or  dangerous  complications  both  during  and  after 
the  administration.  Except  in  emergencies  that  seldom  occur  in 
dental  practice,  an  anesthetist  is  not  justified  in  administering  ether 
or  chloroform  without  first  ascertaining  that  no  disease  exists  in  heart, 
lungs,  brain,  bloodvessels  and  kidneys,  sufficient  to  constitute  a  con- 
traindication. It  is  wise  to  examine  the  patient's  urine  in  every 
case. 

To  this  routine  is  added  the  positive  injunction  to  the  patient  to  take 
nothing  into  the  stomach  for  at  least  five  hours  before  the  operation  is 
to  occur.  This  will  avoid  vomiting  during  the  administration.  A  free 
cathartic  should  be  employed  within  the  twenty-four  hours  preceding 
the  operation,  particularly  if  constipation  is  present. 

An  important  precaution,  that  should  invariably  be  taken  if  the  patient 
be  a  woman,  is  to  have  a  third  party  present,  which  in  case  of  dental 
operations  may  preferably  be  a  friend  of  the  patient.  A  case  is  recorded 
where  the  imaginations  of  an  anesthetized  woman  were  such  as  to  form 
the  basis  of  a  charge  of  criminal  assault  against  the  operator;*  therefore 
one  should  guard  against  such  an  unfortunate  possibility  in  any  case  of 
anesthesia  under  his  direction. 

Coming  to  the  time  of  administration,  any  artificial  denture  or  other 
appliance  must  be  removed  from  the  mouth.  When  ether  or  chloroform 
is  to  be  used  it  is  well  to  protect  the  eyes  from  the  irritating  vapor  by 
covering  them  with  a  towel.  If  the  greatest  care  is  not  exercised  as  to 
quantity  of  liquid  applied  to  the  inhaler  it  may  drop  upon  the  face  and 
irritate  the  skin.  Some  anesthetists  protect  the  tissues  about  the  mouth 
and  nose  by  covering  the  skin  and  lips  with  a  light  application  of  sweet 
oil  or  vaseline.  The  patient  must  be  informed  of  the  probable  unpleas- 
antness of  the  vapor,  so  as  not  to  be  surprised  by  the  sense  of  suffocation. 
The  clothing  about  the  neck,  chest  and  waist  should  be  sufficiently 
loose  to  allow  of  free  respiratory  movements,  and  the  patient  should 
finally  be  instructed  to  breathe  deeply. 

In  case  of  emergency  requiring  an  operation  at  night,  ether  must  not 
be  used  in  the  presence  of  a  gas  flame  or  ordinary  fire.    The  vapor  of 

*  Reese.    Medical  Jurisprudence  and  Toxicology,  second  edition,  p.  559. 


ANESTHETICS  183 

ether  is  explosive.^  It  is  also  heavier  than  the  air,  and  will  fall  to  the 
floor  and  diffuse  itself  mainly  in  the  lower  part  of  the  room.  It  may^ 
therefore,  reach  an  open  fire  at  some  distance  in  explosive  strength, 
without  being  particularly  evident  in  the  upper  part  of  the  room.  The 
only  safe  light  to  use  about  ether  is  the  incandescent  electric  light,  which 
is  fully  enclosed.  For  the  same  reason,  it  is  necessary  to  observe  some 
care  in  handling  ether.  It  should  be  kept  and  handled  in  tin  cans  rather 
than  in  bottles,  in  order  to  avoid  accidental  breakage  with  diffusion  of 
the  explosive  vapor. 

Responsibility  in  the  Use  of  Anesthetics.  With  all  precautions  taken, 
it  still  remains  a  fact  that  occasional  deaths  attend  the  use  of  anesthetics. 
Therefore,  the  question  of  responsibility  in  their  use  becomes  an  impor- 
tant one.  For  slight  operations,  such  as  tooth  extraction,  that  do  not 
absolutely  recjuire  it,  it  is  well  to  place  the  responsibility  of  deciding  for 
an  anesthetic  upon  the  patient.  With  the  decision  made  and  the  proper 
agent  selected,  it  remains  with  the  operator  to  bring  to  its  administration 
the  requisite  knowledge  and  skill ;  and  the  dental  practitioner  must  deter- 
mine how  far  he  will  here  assume  the  responsibility.  It  must  be  said 
that  the  dental  curriculum  of  study  does  not  provide  sufficiently  for 
training  in  physical  diagnosis  and  general  clinical  work  to  fit  the  dental 
specialist  for  the  office  of  anesthetist.  It  is  doubtless  proper  for  him  to 
administer  nitrous  oxide,  but  to  be  prepared  in  all  points  that  are 
involved  in  the  use  of  ether  and  chloroform  requires  a  broad  medical 
training  and  considerable  experience.  The  course  that  is  most  natural, 
and  that  places  the  responsibility  where  it  really  belongs,  is  to  refer  the 

*  In  order  to  ascertain  the  degree  of  explosiveness  of  ether  vapor,  a  series  of  ten 
experiments  were  made  by  Government  Chemist  Albert  P.  Sy,  M.S.,  at  the  Sandy 
Hook  Proving  Grounds,  in  March,  1904.  The  tests  were  made  with  mixtures  of 
ether  vapor  and  air  in  strong  glass  flasks,  through  which  the  electric  spark  was 
passed,  explosion  being  evidenced  by  blowing  out  of  the  cork.  In  four  of  the  ex- 
periments, with  mixtures  containing  from  0.93  per  cent,  to  1.65  per  cent,  by  volume 
of  ether  vapor,  no  explosion  occurred;  while  the  other  six  experiments,  with  mixtures 
containing  from  1.67  per  cent,  to  2.39  per  cent,  by  volume  of  ether  vapor,  were  each 
attended  by  explosion.  The  minimmn  percentage  attended  by  explosion  was  1.67  by 
volume,  which  is  the  equivalent  of  0.355  pound  of  ether  vaporized  in  100  cubic  feet 
of  air.     Report  of  War  Department,  Chief  of  Ordnance,  1904,  vol.  x.  p.  163. 

These  experiments  would  seem  to  indicate  that  in  a  room  of  1000  cubic  feet  space 
(10x10x10  feet)  anything  less  than  3.5  pounds  of  ether  could  be  vaporized  with- 
out danger  of  explosion.  This  degree  of  concentration  would  never  occur  with  the 
ordinary  use  of  ether  as  an  anesthetic.  The  chief  danger  would  probably  be  in  the 
irregular  diffusion  of  the  vapor  by  reason  of  its  weight,  allowing  concentration  in 
some  part  of  the  room  near  a  flame. 


184  GENERAL   REMEDIES 

whole  matter  of  general  anesthesia  in  any  case  to  the  patient's  own 
physician,  both  for  decision  as  to  the  propriety  of  anesthesia  and  selec- 
tion of  the  agent,  and  also  for  its  administration  and  the  general  care  of 
the  patient.  These  suggestions  are  based  upon  an  appreciation  of  what 
might  be  the  result  of  an  accidental  death,  where  it  was  made  evident 
that  the  anesthetic  was  employed  without  every  reasonable  precaution 
having  been  taken. 

Nitrous  Oxide  (not  official).  A  gas  having  the  formula  NjO,  capable 
of  being  liquefied  under  pressure.  It  is  colorless,  odorless,  and  has  a 
sweetish  taste.  It  is  soluble  in  water  and  in  alcohol.  It  is  not  com- 
bustible, but  will  support  combustion. 

This  gas  was  formerly  prepared  by  the  practitioner  for  his  own  use, 
by  heating  ammonium  nitrate  in  a  retort  to  the  point  of  decomposition. 
It  was  collected  and  stored  for  use  in  an  ordinary  gas  tank  over  water. 
Care  had  to  be  exercised  to  avoid  a  degree  of  heat  that  would  develop 
the  higher,  poisonous  oxides  of  nitrogen.  This  method  of  home  manu- 
facture is  now  wellnigh  obsolete,  as  the  gas  can  be  obtained  in  liquid 
form  in  cylinders  of  convenient  size,  and  with  greater  assurance  of 
purity. 

Nitrous  oxide  is  non-irritating  when  inhaled,  and  it  has  been  abun- 
dantly proven  to  be  the  safest  general  anesthetic  known.  Its  effects 
upon  vital  structures  are  so  slight  and  unimportant,  and  the  duration  of 
its  main  effect  so  brief,  that  in  properly  selected  cases  it  should  be  abso- 
lutely safe.  With  the  very  few  cases  of  reported  death  from  inhalation 
of  this  gas,  it  may  be  questioned  whether  the  results  could  be  attributed 
entirely  to  it.  It  has  been  largely  used  to  induce  transient  anesthesia  for 
slight  operations,  its  most  extensive  use  having  been  for  tooth  extraction. 
At  present  it  is  also  used  in  general  surgery,  and  its  use  has  been  extended 
in  two  special  ways,  jirst,  by  its  employment  to  secure  anesthesia  quickly, 
to  be  followed  by  ether,  thus  shortening  the  period  and  removing  the 
unpleasantness  of  the  early  part  of  ether  administration ;  and  second,  by 
its  combined  inhalation  with  oxygen,  whereby  the  element  of  asphyxia 
is  removed,  permitting  the  anesthesia  to  be  continued  indefinitely  as  with 
other  agents.  This  latter  method  is  undoubtedly  destined  to  greater 
use  in  cases  where  other  anesthetics  are  contraindicated. 

Complete  anesthesia  may  usually  be  induced  by  pure  nitrous  oxide 
in  from  two  to  five  minutes,  and  recovery  occurs  in  an  equally  short  time. 
With  the  full  effect  obtained  quickly,  it  is  not  so  easy  to  define  stages  of 
action,  but  we  may  note  about  the  same  order  of  paralysis  as  with  ether. 
The  disturbance  of  consciousness  is  quite  characteristic,  in  that  the 


\^^-^^^ 


Cerebellum 


-Section  of  j.  — -j 
I  Capillary  Ai\  *S' 


Late  Effec\  K 


Vagus  Cent\ 

Vaso  Motor 

Center 
'Cervical 
Sympathetic 


-Solar  Plexu 


The  bluJ^te 


blue  color  indi 
depression  cause 
chloroform. 


PLATE    VI. 


PLATE    VII. 


Va(ius  Center 

Vaso  Motor 

Center 
'Cervical 
Sympathetie 


Solar  Plexus 


^THEE. 


CHLOROFORMUM. 


Classified  as  : 
Stimulant.  Anodyne.  Irritant.  Anodyne. 

Auestlietic.  Anesthetic.         Antispasmodic. 

The  action  of  these  two  substances  is  very  similar,  the  main  differences  being  in  the  degree  in 
which  they  aiTect  various  organs. 
Physiologic  action  : 


The  blue  color  indicates  depression 
caused  by  ether. 


Ether,  in  the  concentrated  form  in 
wliich  it  is  administered,  is  more  irri- 
tating than  chloroform,  tlierefore  the  pri- 
mary reflex  stimulation  and  the  later 
excitement  are  much  more  pronounced. 

It  may  cause  danger  by  paralysis  of 
respiration,  but  the  heart  is  depressed 
so  slightly  that  recovery  may  usually  be 
secured. 


Locally  applied,  the  drug  is  an  irritant. 


Nervous  System. 

Brain.  Depresses  cerebrum,  abolish- 
ing all  of  its  functions. 

Medulla.  Of  the  whole  central  ner- 
vous system  the  medidla  is  affected 
last.  In  dangerous  narcosis  the  re- 
spiratory and  vasomotor  centers  a."e 
paralyzed. 

Spinal   cord.     Abolishes  all  func- 
tions, the  sensory  side  being  paral- 
yzed before  the  motor. 
Oirculafion, 

Not  much  altered  from  the  normal  un- 
til anesthesia  is  profound,  when  ar- 
terial pressure  is  diminished. 

Heart.  Early  may  show  reflex  stimu- 
lation. Later  not  much  affected 
unless  administration  is  prolonged, 
when  some  depression  may  occur. 

Capillary  area.    Some  dilatation  of 
cutaneous  arterioles  usually  occurs, 
with  flusliing  of  the  face. 
Eye.  Early  the  pupils  are  dilated.  During 
complete   anesthesia   they   are   con- 
tracted.    With  dangerous  paralysis 
they  dilate. 
Mespiration.     May   be    irregular    or   in- 
terrupted during  partial  anesthesia. 
During  full   anesthesia  it  is  regular 
and  normal,   as   during    sleep.      In 
dangerous  narcosis  it  fails,  through 
paialysis  of  the  respiratory  center. 
Temperature  is  i-educed  during  anesthesia. 
Metabolism.     Influence  is  usually  slight 
and  transient.  The  drug  is  eliminated 
chiefly  by  the  lungs. 


Cliloroform  is  pleasanter  to  inhale,  but  much 
more  depressant  to  nerve  centers  and  heart. 

According  to  Cushny.it  is  3  to  Si,^  times  as  de- 
pressant to  the  central  nervous  system,  and  36  to 
48  times  as  depressant  to  the  heart,  as  is  ether. 

It  usually  causes  death  by  paralysis  of  respi- 
i^tion,  the  heart  continmng  to  beat,  though  so 
greatly  depressed  as  to  prevent  recovery  in 
many  cases.  However,  it  is  believed  by  many 
that  the  heart  may  in  some  cases  be  paiulyzed 
first.  This  is  probably  true  in  cases  of  degen- 
eration of  the  heart. 

Locally  applied,  the  drug  is  an  irritant,  es- 
pecially when  the  vapor  is  confined,  as  in  the 
production  of  a  "  thimble  blister." 

Nervous  System. 
Brain.    Depresses  the  cerebrum,  abolishing 

all  of  its  functions. 
Medulla.     Of  the  whole  central  nervous 
system  the  medulla  is  affected  last.     In 

dangerous    narcosis    the    respiratory  and    vasomotor    centers    are 
paralyzed. 

Spinal  cord.  Abolishes  all  functions,  the  sensory  side  being  paral- 
yzed before  the  motor. 

Circulation. 

Much  more  depressed  by  chloroform  than  by  ether.  Arterial  press- 
ure decidedly  diminished,  probably  by  both  cardiac  and  vasomotor 
depression. 

Heart.  Depresses  the  heart  muscle  or  its  ganglia.  By  prolonged 
action  may  cause  fatty  degeneration. 


Capillary  area.     Arterioles  relaxed  by  vasomotor  depression. 


Eye.     Early  the  pupils  are  dilated.      During  complete  anesthesia  they 
are  contracted.     With  dangerous  paralysis  they  dilate. 


piratlon.  During  partial  anesthesia  it  is  disturbed  in  a  reflex  way 
less  than  with  ether.  During  full  anesthesia  it  is  regular  and  nor- 
mal as  during  sleep.  In  dangerous  narcosis  it  fails  through  paralysis 
of  the  respiratory  center. 


Temperature  is  reduced  during  anesthesia. 

Metatiolism.  Destruction  of  proteids  is  increased  with  less  perfect  oxida- 
tion. Fatty  degenei'ation  of  heart,  liver  and  kidneys  may  occur. 
The  drug  is  eliminated  chiefly  by  the  limgs,  but  it  has  been  found  in 
the  urine. 


The  blue  color  indicates 
depression  cajsed  by- 
chloroform. 


ANESTHETICS  185 

emotions  are  prominently  affected,  laughing  being  so  often  induced  as 
to  lead  to  the  popular  designation  of  the  substance  as  "laughing  gas." 
Reflex  activity  is  likewise  often  evident,  the  patient  sometimes  even 
needing  restraint. 

When  the  gas  is  given  mixed  with  air,  the  excitement  is  apt  to  be 
greater  and  the  anesthetic  effect  more  slowly  produced.  The  most 
striking  feature  of  nitrous  oxide  anesthesia  produced  rapidly,  is  cyanosis 
due  to  the  exclusion  of  oxygen — really  asphyxia.  It  has  been  held  by 
some  that  anesthesia  by  this  agent  is  simply  asphyxia;  but,  although 
asphyxia  will  induce  unconsciousness,  it  is  easily  demonstrable  that 
nitrous  oxide  has  a  specific  anesthetic  action,  for,  with  a  patient  fully 
under  its  influence,  the  combined  inhalation  of  oxygen  and  nitrous  oxide 
will  remove  the  asphyxia  without  terminating  the  anesthesia,  which  will 
continue  as  long  as  nitrous  oxide  is  administered. 

.ffither.  Ether.  Ethylic  Ether.  Composed  of  96  per  cent,  of  ethyl 
oxide  [(02115)20]  and  4  per  cent,  of  alcohol;  prepared  by  the  action  of 
sulphuric  acid  upon  alcohol,  hence  sometimes  called  "sulphuric"  ether. 
It  is  a  light,  colorless,  volatile  liquid,  with  a  penetrating  odor  and  dis- 
agreeable, burning  taste,  having  a  specific  gravity  of  0.716  to  0.717  at 
25°  C.  (77°  F.).  Its  vapor  is  heavier  than  air,  and  may  be  explosive 
when  mixed  with  air  and  brought  into  contact  with  a  flame.  It  is  sol- 
uble in  about  10  times  its  volume  of  water,  and  is  miscible  with  alcohol, 
chloroform  and  oils. 

Ether  boils  at  about  35°  C.  (95°  F.).  One  official  test  of  its  strength  is 
that,  in  a  test-tube  half-filled  and  containing  fragments  of  broken  glass, 
it  should  boil  by  the  heat  of  the  hand,  when  the  tube  is  closely  grasped 
and  held  for  some  time.  The  vapor  being  explosive,  ether  should  be 
kept  in  tin  cans  so  as  to  avoid  danger  of  breakage  with  rapid  diffusion 
of  the  vapor.* 

Plate  VI.  represents  the  action  of  ether  upon  the  central  nervous 
system,  the  respiration  and  the  circulation.  (For  preparations  and 
doses,  see  Index  of  Drugs.) 

Administration  of  Ether.  Ether  is  best  administered  by  an  inhaler 
that  admits  sufficient  air  for  oxygenation,  but  so  arranged  that  the  air 
becomes  saturated  with  the  ether  vapor.  For  occasional  administration 
no  inhaler  is  better  than  one  prepared  at  the  time  by  folding  within  a 
towel  a  newspaper  of  ordinary  size,  previously  folded  to  a  width  of  5 
or  6  inches ;  then  rolling  into  proper  shape  to  fit  about  the  mouth  and 

*  Regarding  the  degree  of  explosives  of  ether  vapor,  see  note,  p.  183. 


186  GENERAL  REMEDIES 

nose,  and  pinning  securely,  the  towel  being  pinned  loosely  also  at  the 
distal  end.  The  folded  newspaper  is  sufficiently  impervious  to  prevent 
loss  of  ether  and  it  makes  a  firm  cone.  A  piece  of  gauze  or  cotton  placed 
within  will  hold  the  ether,  which  is  at  intervals  poured  directly  upon  it. 
In  hospitals  the  drop  method  has  come  into  favor.  It  consists  of  the 
use  of  a  number  of  layers  of  gauze  about  6  inches  square,  pinned  upon  a 
simple  wire  frame  like  that  of  the  Esmarch  inhaler.  Upon  this  the  ether 
is  dropped  quite  constantly,  insuring  saturation  of  the  air  inhaled. 

Ether  is  frequently  preceded  by  ethyl  chloride  or  nitrous  oxide  to  the 
point  of  unconsciousness. 

General  Uses.  When  applied  to  the  skin  the  rapid  evaporation  of 
ether  causes  a  decided  cooling  of  the  surface;  applied  to  the  mucous 
membrane  it  is  irritating.  The  stimulant  use  of  ether  preparations 
depends  largely  upon  this  irritant  quality.  The  spirit  and  compound 
spirit  are  employed  in  moderate  doses  as  stimulants,  the  effect  being 
reflex  from  local  irritation  of  the  mucous  membrane.  In  large  doses 
these  preparations  are  anodyne  after  absorption. 

.  Ether  is  also  a  valuable  solvent  for  resins,  oils,  iodoform  and  many 
other  substances  not  readily  soluble  in  water. 

Chloroformum.  Chloroform  [CHCI3].  This  substance  is  prepared 
by  the  action  of  chlorine  with  an  alkali  upon  alcohol,  and  is  composed 
of  99  to  99.4  per  cent,  by  weight  of  absolute  chloroform  and  1  to  0.6  per 
cent,  of  alcohol.  (For  preparations  and  doses,  see  Index  of  Drugs.) 
It  is  a  heavy,  colorless,  volatile  liquid,  with  an  ethereal  odor  and  sweet, 
burning  taste,  having  a  specific  gravity  of  not  less  than  1.476  at  25°  C. 
(77°  F.).  It  is  soluble  in  200  volumes  of  cold  water  and  freely  in  alcohol, 
ether,  benzin,  benzol  and  the  fixed  and  volatile  oils.  Chloroform  should 
be  kept  in  dark-colored  bottles  in  a  cool  and  dark  place.  It  is  not 
inflammable,  but  its  heated  vapor  will  burn. 

Plate  VII.  represents  the  action  of  chloroform  upon  the  central 
nervous  system,  the  respiration  and  the  circulation. 

Uses.  As  a  General  Anesthetic.  In  its  practical  application  it  has 
been  found  to  be  jive  times  as  dangerous  as  ether,  chiefly  on  account  of 
its  depressant  action  upon  the  heart.  Therefore,  it  should  not  be  used 
except  in  suitable  cases,  and  where  the  use  of  ether  is  impracticable. 
When  it  is  employed,  the  patient  should  be  in  the  recumbent  posture 
throughout  the  period  of  anesthesia,  in  order  to  reduce  the  work  of  the 
heart  to  a  minimum.  This  being  often  impossible  in  dental  operations, 
furnishes  additional  reason  for  its  non-employment.  Indeed,  the 
relatively  high  death-rate  from  the  use  of  this  agent  in  the  dental  chair 


ANESTHETICS 


187 


proves  the  danger  of  the  sitting  posture  when  the  heart  is  depressed 
by  chloroform. 

When  used  as  an  anesthetic  this  drug  must  be  administered  very 
cautiously.  The  greatest  danger  seems  to  be  from  too  rapid  admin- 
istration, whereby  the  blood  receives  a  large  amount  of  the  vapor  in  a 
very  short  space  of  time.  In  this  way  the  heart  may  be  depressed  beyond 
recovery  at  any  time  during  administration.  To  guard  against  this, 
chloroform  should  be  given  largely  diluted  with  air,  from  an  inhaler 
that  cannot  fit  closely  enough  to  exclude  air.  A  convenient  and  simple 
one  consists  of  a  wire  form  four  inches  in  diameter  with  a  concavity 
to  prevent  contact  with  the  nose.     This  is  covered  with  a  few  layers  of 


Fig.  5 


Esmarch's  inhaler  and  chloroform  bottle.     The  inhaler  consists  of  a  wire  frame 
covered  with  a  piece  of  flannel  or  gauze. 

gauze,  upon  which  the  chloroform  is  dropped  in  small  cjuantities  (ten 
to  twelve  drops)  frequently.  (See  Fig.  5.)  The  inspired  air  should 
never  contain  more  than  2  per  cent,  of  the  vapor  of  chloroform.  This  is 
in  accordance  with  the  conclusions  of  the  Special  British  Chloroform 
Committee,*  to  the  effect  that  1  to  2  per  cent  of  chloroform  in  the  air 
is  sufficient  for  anesthesia,  and  that  these  proportions  are  safe;  0.5  per 
cent,  is  inefficient,  while  5  per  cent,  is  dangerous. 

As  Anodyne.  Toothache  may  frequently  be  relieved  by  placing  a 
loose  pledget  of  cotton  saturated  with  chloroform  between  the  cheek 
and  the  alveolus  of  the  affected  tooth. 

In  gastric  or  intestinal  colic  the  drug  may  be  given  in  a  dose  of  5- 
ISHfL  (0.30-1  cc),  dropped  upon  sugar  or  mixed  with  a  fixed  oil. 
*  Supplement,  British  Medical  Journal,  1903. 


188  GEXEEAL  REMEDIES 

In  parox^^'sms  of  severe  pain  it  may  be  inhaled  cautiously;  in  labor, 
to  lessen  the  severity  of  the  pains  during  the  expulsive  period.  Its  use 
as  an  anodyne  calls  for  discretion  and  the  avoidance  of  every  possibility 
of  overdosage.  It  should  always  be  given  by  a  physician  or  under  his 
direction,  for  it  is  not  safe  for  a  person  to  inhale  this  drug  by  his  own 
administration. 

As  Antispasmodic.  To  relieve  infantile  convulsions,  actite  paroxysms 
of  asthma,  tiremic  and  puerperal  con^.idsions.  In  these  conditions  it 
should  never  be  employed  except  with  competent  medical  supervision. 

As  Irritant.  It  may  be  used  as  a  counterirritant  in  case  of  neuralgia 
or  other  localized  pain.  The  effect  will  vary  from  mild  irritation  to  the 
production  of  a  blister,  according  to  duration  of  the  application.  If  the 
vapor  be  completely  confined,  as  by  placing  the  drug  upon  cotton  and 
covering  with  a  thimble,  a  small  blister  ('' thimble  blister")  is  quickly 
produced. 

As  Solvent.  Chloroform  is  used  as  a  solvent  for  oils^  some  resins, 
caoutchouc,  gutta-percha,  etc. 

.fflthylis  Chloridiun ,  Ethyl  Chloride  [C2H5CI].  This  drug  is  pre- 
pared by  the  action  of  hydrochloric  acid  gas  upon  absolute  alcohol.  It 
is  a  very  volatile,  colorless  licjuid,  ha\'ing  an  agreeable  odor  and  burning 
taste.  It  is  very  soluble  in  alcohol,  but  only  slightly  in  water.  Its  most 
distmctive  property  is  its  low  boiling  point  (55°  F.;.  Vaporizing  rapidly 
at  ordinary  temperature,  it  is  our  most  valuable  and  convenient  refrig- 
erant analgesic.  The  vapor  is  very  inflammable,  therefore  it  should  not 
be  used  near  a  flame.  As  a  general  anesthetic,  ethyl  chloride  has  now 
been  in  use  for  several  years,  both  as  preliminary  to  ether  and  chloroform, 
and  used  alone  to  induce  transient  anesthesia.  It  belongs  in  a  class 
with  nitrous  oxide  rather  than  with  ether  and  chloroform,  in  that  it  is 
best  adapted  to  minor  operations  that  do  not  require  profound  or  con- 
tinued anesthesia.  Being  a  new  agent,  its  relative  safety  among  anes- 
thetics has  not  yet  been  definitely  fixed  by  accumulated  statistics,  but 
experience  thus  far  places  it  about  equal  with  ether,  or  less  safe.  V  ith 
longer  experience  in  its  use  it  may  come  to  rank  higher,  but  it  is  cer- 
tainly less  safe  than  nitrous  oxide. 

An  early  series  of  12,436  cases  of  anesthesia  with  ethyl  chloride  gives 
only  one  death  that  was  proved  to  have  been  due  to  the  drug.  That  case 
had  a  history  of  alcoholic  abuse  and  the  autopsy  revealed  degeneration 
of  heart  and  arteries.* 

*  Lotheisen.     Miinch.  Med.  Woch.,  Xovember  18,  1900.  p.  601. 


ANESTHETICS  189 

McCardie  *  in  2000  cases  saw  neither  asph}'xia  nor  syncope  in  any 
case.  His  estimate  later  gives  one  death  in  3000  cases.  He  has  collected 
records  of  21  deaths,  and  states  that  at  least  30  deaths  are  known  to  have 
occurred  under  ethyl  chloride,  while  several  others  have  occurred  from 
the  proprietary  mixture  called  somnoform. 

Of  the  21  deaths  recorded,  only  3  were  of  children,  and  8  occurred 
in  dental  cases. 

In  these  cases  the  "closed  method"  of  inhalation  is  believed  to  have 
been  commonly  employed.  This  may  have  contributed  an  element  of 
danger;  for  it  cannot  be  too  strongly  emphasized  that,  with  so  powerful 
agents  as  chloroform,  ethyl  chloride  and  ether,  the  limitation  of  air,  by 
use  of  a  closed  inhaler  or  a  bag  which  requires  rebreathing  of  the  vapor- 
laden  air,  adds  a  danger  of  auto-intoxication  which  cannot  be  ignored. 

Experiences  thus  far  lead  the  above  author  to  regard  ethyl  chloride 
as  a  substitute  for  ether  and  chloroform  rather  than  for  nitrous  oxide, 
though  in  children  under  eight  it  is  usually  to  be  preferred  to  nitrous 
oxide.  It  is  to  be  used  with  caution  in  dental  cases,  and  the  recumbent 
posture  is  advised. 

Its  depressant  action  is  more  evident  upon  the  respiration  than  upon 
the  circulation.  When  inhaled  pure,  v/ithout  access  of  air,  it  causes  death 
by  paralyzing  respiration.  In  1000  cases  by  Ware  t  he  noted  6  cases  of 
serious  danger,  all  of  which  were  due  to  interference  with  respiration 
and  all  recovered  under  the  use  of  artificial  respiration.  The  same 
writer,  after  much  experience,  adapts  the  rubber  mouth-piece  of  the 
nitrous  oxide  inhaler  to  ethyl  chloride  (Fig.  G),  as  here  described  in 
his  own  words :  % 

"The  mask  is  prepared  for  use  by  stretching  two  layers  of  small- 
meshed  gauze  over  the  end  of  the  tube  h,  which  is  then  held  taut  by 
being  forced  into  the  neck  c  of  the  funnel-shaped  rubber  mouth-piece  a. 
The  gauze  can  be  renewed  at  will  and  the  whole  apparatus,  because  of 
its  simplicity,  easily  rendered  sterile,  a  feature  devoutly  to  be  wished 
for  in  the  laughing-gas  mask  and  other  kindred  devices.     The  tube  h  is 

*  British  Med.  Jour.,  Mar.  17,  1906.  Here  also  are  noted  the  foUoTv-ing  estimates 
of  the  danger  ratio  of  ethyl  cliloride: 

Lotlaeisen  first  estimated  the  deaths  as  1  :  2500.  A  later  (April,  1902)  estimate 
by  the  same  writer,  gives  only  1  :  17,000. 

Seitz's  estimate,  at  about  the  same  time,  is  1  :  16,000. 

In  comparison,  the  following  estimates  are  given  for  ether  and  nitrous  oxide: 
Ether  deaths,  1  :  16,000;  nitrous  oxide  deaths,  1  :  1,000,000. 

t  Journal  of  the  American  Medical  Association,  No.  8,  1902. 

%  Medical  News,  August  3,  1901,  p.  169. 


190 


GENERAL  REMEDIES 


the  channel  along  which  the  stream  of  ethyl  chloride  is  directed  against 
the  gauze  c,  intended,  not  merely  to  receive  the  ethyl  chloride,  but  also 
by  impact  to  break  it  into  still  finer  particles.  At  this  point  the  ethyl 
chloride,  evaporating,  expands  and  is  held  by  the  walls  of  the  mouth- 
piece a  and  the  sides  of  the  tube  h,  which,  therefore,  act  as  a  chamber  to 
temporarily  limit  the  vapors. 

"The  entrance  and  exit  of  air  are  through  one  orifice,  so  as  to  min- 
imize the  loss  of  ethyl  chloride  and  merely  utilize  the  quantity  moment- 
arily available  for  one  or  two  respiratory  acts.  The  stream  is  to  be 
delivered  intermittently  from  tubes  provided  with  an  automatic  cut-off." 

Fig.  6 


"With  ethyl  chloride  administered  as  described  above,  with  proper 
admixture  of  air,  anesthesia  is  induced  in  about  the  same  time  as  nitrous 
oxide  requires;  the  effects  correspond  very  closely  to  those  of  the  latter 
as  to  duration  and  recovery,  but  cyanosis  is  absent  throughout. 

For  use  in  dental  practice  it  may  be  said  that,  compared  with  nitrous 
oxide,  ethyl  chloride  is  more  convenient,  about  as  cheap,  and  equally 
efficient,  though  less  safe  and  requiring  selection  of  cases  and  cautious 
use. 

Somnoform,  a  proprietary  mixture  of  ethyl  chloride  60  parts,  methyl 
chloride  35  parts,  and  ethyl  bromide  5  parts,  presents  no  advantage 
over  pure  ethyl  chloride.  Several  deaths  from  its  use  have  been 
reported. 

Comparative  Safety  of  Anesthetics.  The  relative  toxicity  of  these 
agents  must  depend  largely  upon  their  chemical  make-up.  If  we  com- 
pare the  chemical  formula?  of  the  four  leading  anesthetics,  viz. : 

Nitrous  oxide N^O 

Ether C.HjqO 

Ethyl  chloride C,B.f\ 

Chloroform CHCL, 


ANESTHETICS  191 

we  note  differences  that  correspond  to  the  increase  in  toxic  power. 
Nitrous  oxide  is  a  very  simple  compound  that  has  slight  effect  upon  pro- 
toplasm. The  hydrocarbon  compounds  have  a  more  decided  effect, 
that  of  ether  being  prolonged  and  profound  without  much  danger  from 
its  action  upon  vital  tissues;  but  with  the  introduction  of  a  halogen 
element  in  combination  with  the  organic  radical,  we  find  the  harmful 
action  to  increase  in  proportion  to  the  number  of  halogen  atoms  in  the 
molecule.  Thus,  ethyl  chloride  contains  a  chlorine  atom  which  makes 
it  more  toxic;  while  chloroform,  with  three  atoms  of  chlorine,  is  decidedly 
poisonous  to  tissues,  frequently  causing  a  positive  degeneration. 

From  these  observations  we  are  led  to  be  skeptical  as  to  the  claims  of 
safety  for  any  new  anesthetic  containing  a  halogen  element. 

Briefly  then,  it  may  be  stated  for  the  agents  now  most  employed,  that 
nitrous  oxide  is  the  safest  anesthetic  in  ordinary  use;  next  in  point  of 
safety  are  ether  and  chloride  of  ethyl,  while  chloroform  remains  the  least 
safe.  The  comparative  safety  of  ether  and  chloroform,  as  given  in  a 
number  of  series  of  statistics,  shows  some  variation,  but  it  may  be  taken 
as  a  fair  statement  that  ether  is  five  times  as  safe  as  chloroform.* 

A  very  interesting  study  of  this  question  is  that  presented  by  the 
Committee  of  the  British  Medical  Association  appointed  to  investigate 
clinically  the  safety  of  the  several  anesthetics. f  They  studied  25,920 
cases  of  general  anesthesia,  all  occurring  in  the  United  Kingdom  in  the 
year  1892.  Their  conclusions  include  not  simply  deaths  from  anesthetics, 
but  all  cases  of  danger  that  could  be  attributed  to  the  agent- used.  They 
found  that  dangerous  symptoms  occurred: 

With  ether,  in  0.065  per  cent,  of  cases. 

With  nitrous  oxide  and  ether,  in  0.096  per  cent.,  and 

With  chloroform,  in  0,582  per  cent. 

This  would  make  the  danger  ratio  about  as  follows: 

Chloroform,  9 

Nitrous  oxide  and  ether,  1 .5 

Ether,  1 

It  is  conceded  that  nitrous  oxide  alone  is  least  dangerous  of  all. 
Mixtures  of  Anesthetics.     Besides   the   combined   use   of   ether   with 

*  In  connection  with  this,  it  is  interesting  to  note  the  estimate  of  the  comparative 
anesthetic  power  of  ether  and  chloroform.  It  has  been  stated,  as  a  result  of  experi- 
ments, that  "  the  concentration  of  ether  in  serum  necessary  for  complete  anesthesia 
is  1:400;  of  chloroform,  1:4500  to  1:6000."  Cited  from  Sollmann,  American 
Medicine,  September  10,  1904,  p.  455. 

f  Lancet,  London,  1901,  vol.  i.  p.  280. 


192  GENERAL  REMEDIES 

nitrous  oxide  or  ethyl  chloride,  mixtures  of  anesthetics  cannot  be  very 
strongly  advised.  The  old  A.  C.  E.  mixture  of  alcohol  1  part,  chloroform 
2  parts,  and  ether  3  parts  is  now  seldom  used.  The  differences  in 
specific  gravity  and  volatility  of  the  several  liquids,  make  it  difficult  to 
know  what  proportion  of  each  the  vapor  contains.  The  Schleich  mixtures 
for  general  anesthesia  are  not  regarded,  in  general,  with  sufficient  favor 
to  constitute  any  recommendation  of  them.  These  must  not  be  confused 
with  the  solutions  for  local  analgesia,  discussed  on  page  162.  Schleich's 
idea  in  introducing  mixtures  of  anesthetics  for  general  anesthesia,  was 
to  obtain  a  liquid  with  a  desired  boiling  point  (at  about  the  tempera- 
ture of  the  blood),  to  secure  which  he  employed  mixtures  of  ether, 
chloroform  and  petroleum  ether  with  boiling  points  varying  between 
about  100°  and  108°  F.  His  belief  in  the  relation  between  the  action 
of  an  anesthetic  and  its  boiling  point  has  not  been  accepted. 

The  mixture  called  somnoform  (also  advertised  under  the  name  of 
Brugg's  Mixture)  cannot  be  advised  for  the  following  reasons : 

1.  Being  proprietary,  its  use  is  unethical. 

2.  It  contains  5  per  cent,  of  ethyl  bromide  [C2H5Br],  which  substance 
is  regarded  as  less  safe  than  ethyl  chloride.* 

3.  With  new  agents,  such  as  ethyl  chloride,  it  is  better  to  use  the  simple 
substance  until  its  degree  of  safety  has  been  determined,  before  resorting 
to  any  modification  of  it. 

Resuscitation  in  Danger  Cases.  With  nitrous  oxide,  ethyl  chloride, 
ether,  and  usually  with  chloroform,  the  danger  is  paralysis  of  respiration. 
When  the  condition  is  simply  this,  recovery  may  be  expected,  with 
proper  treatment.  But  while  the  condition  is  a  simple  one  with  the 
three  first-named  agents,  with  chloroform  there  is  always  added  a 
serious  depression  of  the  heart,  and  occasionally  paralysis  of  that  organ. 
When  the  heart  is  paralyzed  by  chloroform  its  irritability  is  lost,  which 
means  death.  But  absence  of  the  pulse  beat  must  not  be  at  once  taken 
to  mean  paralysis,  for,  with  the  depressant  action  of  the  drug  upon  the 
heart,  its  pulsations  may  have  become  so  feeble  as  to  be  imperceptible 
in  the  peripheral  vessels;  and  it  is  not  proper  to  w^aste  time  at  first  to 
ascertain  the  heart's  condition.  The  important  thing  immediately  is  arti- 
ficial respiration,  which  is  itself  here  the  best  cardiac  stimulant,  and  with 
its  faithful  continuance  the  real  condition  of  the  heart  will  soon  appear; 

*  Sollmann  (Pharmacology,  1906,  p.  436)  states  that  ethyl  bromide  "  must  not 
be  pushed  to  the  disappearance  of  reflexes,  since  the  respiration  is  paralyzed  about 
the  same  time.  The  zone  of  safety  is,  therefore,  very  narrow."  The  drug  also 
deteriorates  rapidly  after  exposure  to  air. 


ANESTHETICS  193 

for  artificial  respiration  not  only  supplies  oxygen  but  facilitates  the  action 
of  the  heart,  by  relieving  engorgement  of  its  chambers,  each  expansion 
of  the  lungs  favoring  the  emptying  of  the  right  ventricle  and  each  contrac- 
tion furnishing  more  blood  to  the  left  side  of  the  heart  for  distribution. 

The  invariable  treatment,  therefore,  when  respiration  ceases,  should 
be  artificial  respiration  with  free  access  of  air,  preceded,  of  course,  by 
withdrawal  of  the  anesthetic.  Sylvester's  method  is  easily  applied  and 
efficient.     (See  Figs.  3  and  4.) 

Massage  of  the  heart,  as  well  as  it  can  be  accomplished  between 
diaphragm  and  thoracic  wall  by  the  hands  of  a  second  person  properly 
applied,  should  accompany  artificial  respiration.  AMiile  these  measures 
are  being  employed  without  interruption,  another  assistant  may  note 
pulse  and  give  respiratory  and  cardiac  stimulants  h\^oderniically,  as 
required.  The  same  medicinal  treatment  will  be  indicated  here  as  in 
poisoning  by  cocaine,  being  careful  to  avoid  vasodilators,  especially  where 
the  arterial  pressure  is  greatly  reduced. 

Strychnine,  atropine,  caffeine  and  digitalis,  therefore,  will  be  the 
drugs  indicated,  the  last  named  being  less  needed  in  cases  of  simple 
asphyxia.  Meanwhile,  the  so-called  diffusible  stimulants,  such  as 
ammonia  by  inhalation  or  the  aromatic  spirit  of  ammonia  by  the  mouth 
(if  swallowing  is  possible),  may  be  given.  The  body  should  be  recum- 
bent, with  the  head  low.  Artificial  respiration  must  be  kept  up  until 
natural  respiration  is  restored,  or  until  the  hopelessness  of  the  case  has 
been  absolutely  established.  If  respiration  is  not  readily  restored  by 
the  above  means,  a  powerful  reflex  influence  may  be  invoked  by  stretch- 
ing the  sphincter  ani.  With  a  rectal  speculum  or  dilator  introduced  into 
the  anus,  rh}i;hmic  manipulation,  so  as  to  stretch  the  sphincter  at  regular 
intervals,  may  be  made.  Drawing  forward  the  tongue  by  the  forceps, 
or  by  a  ligature  passed  through  it,  is  another,  but  less  efficient,  means  of 
reflex  stimulation. 

Alcohol.  Ethylic  Alcohol.  Spiritus  Vini  Redificatus  [C2HgO], 
(For  preparations  and  doses,  see  Index  of  Drugs.)  In  alcohol  we  have 
an  anesthetic  agent  that  is  practically  not  used  as  such.  It  has  been 
commonly  regarded  as  a  stimulant,  but  a  study  of  its  full  action,  com- 
pared with  that  of  ether  and  chloroform,  must  convince  one  of  a  real 
similarity,  approaching  an  identity,  in  their  effects.  "\Miatever  of 
stimulant  effect  it  induces,  seems  to  be  secondary  to  its  local  irritant 
action;  in  this  respect  it  resembles  ethero  Its  full  anesthetic  effect  is  so 
slowly  produced  and  persists  so  long  and  is  attended  with  such  un- 
pleasant symptoms  (those  of  drunkenness),  that  it  cannot  ordinarily  be 

13 


194  GENERAL  REMEDIES 

used  as  an  anesthetic.  That  it  is  a  poison  cannot  be  questioned.  That 
it  is  capable  of  acting  as  a  food  is  in  accordance  with  the  teaching  of  most 
authorities,  but  it  cannot  be  regarded  as  an  economical  food  in  health. 

Its  precise  action  after  absorption  into  the  blood  is  not  fully  under- 
stood, except  that  in  large  doses  it  is  anesthetic  and  poisonous.  This 
latter  fact  should  form  the  basis  of  a  positive  rule  that  alcohol  should  not 
be  given  in  dangerous  narcosis  from  ether  or  chloroform.  It  can  omy 
be  admissible  as  a  reflex  stimulant,  or  as  present  in  the  aromatic  spirit 
of  ammonia  or  in  other  irritating  diffusible  stimulants.  (The  diagrams 
of  Plate  VIII.  are  intended  to  show  the  present  status  of  knowledge 
concerning  the  internal  influence  of  alcohol.) 


ALCOHOI 

Used  commonly  in  the 
Whisky,  Brandy,  or 

Classified  as : 

Irritant.  Stimi 

Astringent.       Narc 
Antiseptic.        Anes 

Physiologic  action  : 

To  summarize  the  ph 
eflTects  of  alcohol 
difficult,  owing  to 
tradictory  opinion! 
good  authorities, 
most  writers  agree 
full  effect  of  a  la: 
of  the  drug  is  tl 
general  depressant 
no  agreement  as  t 
fluence  of  a  small 

Two  diagrams  are  hen 

Diagram  A  represei 

taught  by  those  w 

includes  stiinulatic 

cerebrum  and  of  tl 

Diagram    B    shows 

pressant  action  of 

dose    upon    the 

system,     circulatio 

digestion.   Many  o 

deny  the  primary 

depressant  from  ih 

of  intoxication  is  r 

higher  controlling 

Local  action.     Irritai 

applied  to  the  muc 

tation  probably  in 

in  part  for  the  prii 

Digestion.     In  small 

gastric  secretion  a 

cent,  or  more)  reta 

As  a  food  the  positi 

determined.     A  sr 

from  the   fluids  o1 

changed   into    othc 

tribute  some  enerj 

of  its  use  may  be  o 

Metabolism.     Its  influ 

nation  is  uncertain. 


ALCOHOL. 


PLATE    VIII 


PLATE    VIII.— B. 


Used  commonly  in  the  form  of 
Whisky,  Brandy,  or  Wine. 

Classified  as : 

Irritant.  Stimulant. 

Astringent.       Narcotic. 
Antiseptic.       Anesthetic. 

Physiologic  action  : 
To  summarize  the  physiologic 
eifects  of  alcohol  is  very 
difficult,  owing  to  the  con- 
tradictory opinions  held  by  Skin-^ 
good  authorities.  While 
most  writers  agree  that  the 
full  effect  of  a  large  dose 
of  the  drug  is  that  of  a 
general  depressant,  there  is 
no  agreement  as  to  the  in- 
fluence of  a  small  dose. 

Two  diagrams  are  here  presented  : 

Diagram  A  represents  the  action  of  a  small  dose  as 
taught  by  those  who  hold  that  its  primary  influence 
includes  stimulation  of  the 
cerebrum  and  of  the  heart. 

Diagram  B  shows  tlie  de- 
pressant action  of  a  large 
dose  upon  the  nervous 
system,  circulation,  and 
digestion.   Many  observers 

deny  tlie  primary  stimulant  action,  holding  that  the  drug  is  a 
depressant  from  the  first,  or  even  in  small  dose.  The  excitement 
of  intoxication  is  not  due  to  stimulation,  but  to  depression  of  the 
higher  controlling  centers. 

Local  action.  Irritant,  by  reaison  of  its  aifinity  for  water.  When 
applied  to  the  mucous  membrane  of  the  digestive  tract,  the  irri- 
tation probably  induces  reflex  stimulation,  which  may  account 
in  part  for  the  primary  stimulant  effect  attributed  to  tlie  drug. 

Sigeslion.  In  small  doses,  well  diluted,  alcohol  seems  to  increase 
gastric  secretion  and  motility,  wliile  stronger  solutions  (5  per 
cent,  or  more)  retard  the  digestive  process. 

As  a  food  the  position  of  alcohol  has  not  been  very  definitely 
determined.  A  small  part  only  can  be  recovered  as  alcohol 
irom  the  fluids  of  excretion.  The  greater  part  therefore  is 
changed  into  other  products,  and  is  believed  thereby  to  con- 
tribute some  energy  to  the  body.  The  economy  to  the  system 
of  its  use  may  be  open  to  question. 

Metabolism.  Its  influence  upon  nutritive  changes  and  upon  elimi- 
nation is  uncertain. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


■Solar  Plexus 


CHAPTER  XV. 

STIMULANTS  AND  TONICS. 
STIMULANTS. 

A  STIMULANT  is  usually  defined  to  be  an  agent  that  increases  the 
activity  of  an  organic  function  or  process.  But  in  the  application  of  the 
principle  of  stimulation,  a  qualification  of  this  definition  should  be 
noticed.  We  seek  not  only  to  secure  rapidity,  but  always  efficiency  of  a 
function.  Thus,  in  the  majority  of  cases  that  call  for  a  heart  stimulant 
the  heart's  action  is  already  rapid,  and  our  most  powerful  stimulants, 
such  as  digitalis,  in  their  full  action  actually  slow  the  pulsations  of  the 
heart;  but  in  spite  of  this  the  efficiency  of  the  contraction  is- increased  by 
them  and  the  pulse  improved  in  character.  Again,  the  efficiency  of  a 
function  may  be  lessened  by  undue  inhibitory  restraint.  Here  a  stimu- 
lant result  would  require  that  the  inhibitory  influence  be  weakened. 
Nitroglycerin  acts  somcM^hat  in  such  manner,  allowing  the  heart  to  beat 
more  rapidly  by  depressing  the  vagus  inhibitory  centre. 

Having  in  mind,  therefore,  the  real  object  of  stimulation,  i.  e.,  to 
secure  efficiency  of  a  function,  we  may  employ  agents  that  act  in  various 
ways,  but  always  toward  the  same  object. 

Direct  stimulants  have  their  action  directly  upon  the  organ  or  tissue 
sought  to  be  influenced.  Their  action  may  be  to  increase  nervous, 
muscular  or  secretory  activity.  Such  an  agent  might  be  called  a  kinetic 
stimulant,  in  that  it  changes  latent  into  active  energy.  This  increase 
of  activity  is  at  the  expense  of  the  reserve  energy  of  the  organ,  and  tends 
toward  its  exhaustion.  This  is  an  important  consideration  in  the  choice 
of  a  stimulant,  and,  indeed,  in  the  decision  whether  any  stimulant  shall 
be  employed,  for  the  rapid  exhaustion  of  the  reserve  power  of  an  organ 
may  defeat  the  object  of  our  stimulation. 

There  are  some  stimulants,  however,  to  which  this  objection  scarcely 
applies — ^those  that  simply  increase  the  irritability  of  nerve  or  muscle 
without  calling  forth  any  increase  of  activity,  except  in  response  to 
normal  stimuli.  These  might  be  called  potential  stimulants,  in  that  they 
increase  the  possibility  of  activity  in  response  to  normal  stimuli.  They 
do  not  tend  particularly  toward  exhaustion  of  an  organ.    Strychnine  is 

(195) 


196  GENERAL   REMEDIES 

a  stimulant  of  this  kind,  its  action  being  to  increase  the  irritability  of 
nerve  centres. 

Indirect  stimulants  produce  the  stimulant  result  secondarily.  Some 
of  these  act  primarily  by  removing  inhibitory  influence  and  others  by 
causing  an  irritation  of  sensory  nerves.  Examples  of  the  former  are 
nitroglycerin  and  atropine,  both  of  which  primarily  lessen  the  inhibitory 
influence  of  the  vagus  upon  the  heart,  and  thereby  allow  the  heart  to 
beat  more  rapidly,  which  is  the  secondary  or  indirect  stimulant  effect. 
The  latter  are  exemplified  by  ammonia,  alcohol  and  ether,  which  are 
locally  irritating  to  mucous  membranes.  By  irritating  sensory  nerve 
endings  wherever  applied,  they  induce  a  reflex  or  indirect  stimulant 
effect. 

Some  stimulants  are  poisonous  when  given  in  excessive  dosage;  and 
the  symptoms  of  toxic  disturbances  usually  include  delirium  or  con- 
Aailsions. 

(On  account  of  the  sensitiveness  of  the  system  in  childhood  it  should 
be  noted  that  children  do  not  bear  stimulants  as  well  as  they  do  seda- 
tives. They  present  the  need  of  stimulation  less  often  than  do  older 
persons,  and  the  response  to  stimulants  is  usually  very  prompt.) 

The  Indication  for  Employing  Stimulants  is,  in  general,  any  depression 
o^  a  function  to  a  degree  that  may  be  regarded  as  below  the  physiologic 
minimum  of  its  acti\'ity.  We  recognize  that  e^'ery  organ  has  a  certain 
range  of  action  that  may  be  called  physiologic,  within  which  it  reacts  to 
the  work  demanded  of  it,  by  increasing  or  lessening  its  activity.  Func- 
tional activity,  therefore,  is  a  variable  quantity,  influenced  on  the  one 
hand  by  the  strength  and  nutritive  resources  of  an  organ,  which  are 
opposed  on  the  other  hand  by  the  amount  of  work  imposed  upon  it. 
The  physiologic  minimum  of  activity,  therefore,  must  vary  as  modified 
by  these  influences ;  but  it  may  be  defined  to  be  the  minimum  of  efficiency 
of  a  function  under  existing  conditions.  Now  as  long  as  an  organ  is 
working  efficiently  within  its  physiologic  range  it  needs  no  stimulation. 
But  when,  either  from  its  own  inability  or  from  excessive  demands  made 
upon  it,  its  activity  falls  below  its  physiologic  minimum,  then  stimulation 
may  be  employed  to  compel  an  extra  expenditure  of  energy  in  enforced 
activity. 

It  is  observed,  moreover,  that  normally  acting  organs  do  not  show 
much  response  to  stimulants,  but  that  those  whose  action  is  deficient 
respond  well.  ^Vhen  an  organ  is  doing  all  the  work  that  is  required  of 
it,  it  is  difficult  to  force  its  action ;  but  when  the  need  of  doing  more  work 
is  present  and  a  stimulant  is  applied,  there  appears  to  be  a  co-operation 


STIMULANTS  AXD   TOXICS  197 

of  influences,  the  increased  irritability  or  the  more  'powerful  impression 
contributed  by  the  appHed  stimulant  enabling  the  organ  to  respond  to 
the  need  of  increased  work,  which,  after  all,  is  its  normal  stimulus. 

Thus  defined  and  limited,  stimulants  form  a  very  important  and 
indispensable  class  of  remedies — the  kinetic  stimulants  to  serve  as 
emergency  remedies  to  tide  an  organ  over  a  critical  period,  and  the 
potential  class  to  forestall  failure  of  its  function.  Closely  related  to  the 
latter  are  the  agents  usually  classed  as  tonics,  which  may  supply  elements 
to  the  tissues  or  conserve  the  expenditure  of  energy  by  the  cells. 

Irritant  Stimulants. 

The  indirect  stimulants  that  produce  a  prompt  circulatory  effect  are 
termed  diffusible  siimidants.  They  are  diffusible  in  effect  rather  than 
in  action.  Their  action  is  mostly  a  reflex  one,  following  local  irritation 
of  the  sensory  nerves  in  the  mucous  membrane.  Their  effects  are  usually 
transient. 

Alcohol  (ethylic).  The  local  action  of  this  drug  is  fully  considered 
in  the  chapter  on  Astringents;  but  the  secondary  effects  arising  from  the 
marked  irritation  that  attends  its  abstraction  of  water  from  the  tissues 
and  its  coagulation  of  albumin,  are  those  that  may  be  called  stimulant. 
They  are  reflex  in  nature,  and  are  similar  to  the  reflex  effects  following 
irritation  of  any  sensory  nerve.  Alcohol  should  be  used  in  a  strength 
not  less  than  50  per  cent.,  in  order  to  obtain  the  stimulant  effect,  which 
at  best  is  slight  and  transient.  It  may  be  used  either  diluted  or  in  the 
form  of  whisky  or  brandy.  Pharmacologic  experiments  upon  dogs  do 
not  prove  alcohol  to  be  a  stimulant  after  its  entrance  into  the  circulation; 
there  may  be  a  slight  temporary  increase  of  pulse  rate,  but  arterial 
pressure  is  not  raised. 

On  the  whole,  alcohol  must  rank  as  a  rather  feeble  reflex  stimulant, 
whose  effect  is  uncertain  and  brief,  and  requiring,  for  continued  effect, 
repeated  doses  that  may  later  cause  depression.  For  a  single,  prompt, 
stimulant  result,  as  in  case  of  faintness,  it  is  often  useful. 

It  should  be  remarked  that  what  is  popularly  regarded  as  stimulation 
by  alcohol,  i.  e.,  the  hilarity,  activity  and  talkativeness,  are  not  stimulant 
effects  at  all,  but  rather  the  opposite.  They  correspond  to  the  period  of 
disturbed  or  imperfect  consciousness  common  to  anesthetics,  and  must 
be  regarded  as  uncontrolled  activity  of  the  lower  emotional  and  reflex 
centres,  which  occurs  because  the  controlling  function  of  the  cerebrum 
has  been  depressed. 


198  GENERAL  REMEDIES 

In  large  doses  alcohol  soon  produces  its  characteristic  depression  of 
the  whole  central  nervous  system,  while  its  continued  use  leads  to  degen- 
erative changes  in  the  arterial  system,  kidneys,  liver  and  other  highly 
vascular  organs. 

iEther.  Ether.  (For  doses,  see  Index  of  Drugs.)  This  drug  is  fully 
considered  in  the  chapter  on  Anesthetics.  Its  stimulant  secondary  effects, 
following  primary  irritation,  are  similar  to  those  of  alcohol.  For  use  as 
a  stimulant  it  is  usually  combined  in  the  following  preparations: 

Spiritus  .ffitheris.  Spirit  of  Ether.  This  contains  325  parts  of  ether 
and  675  parts  of  alcohol. 

Spiritus  .ffitheris  Compositus.  Compound  Spirit  of  Ether.  HoJI- 
man's  Anodyne.  This  contains  325  parts  of  ether,  650  parts  of  alcohol 
and  25  parts  of  ethereal  oil. 

These  preparations  are  given  mostly  by  the  stomach.  Hypodermically 
they  are  quite  irritating,  although  this  should  not  prevent  their  use  in 
emergency,  if  swallowing  is  difficult  or  impossible.  Indeed,  the  greater 
irritation  would  likely  induce  greater  reflex  stimulation. 

Ammonia  [NHg].  (For  preparations  and  doses,  see  Index  of  Drugs.) 
This  substance  has  a  decidedly  irritant  local  action,  and  has  the  advan- 
tage of  being  a  gas,  which  permits  of  inhalation.  It  is  also  given  in  solu- 
tion in  water  and  alcohol.  The  gas  is  so  volatile  that  it  is  always  em- 
ployed in  solution,  even  for  inhalation.  In  fact,  the  aqua  ammonise 
fortior  liberates  the  gas  so  rapidly  as  to  be  caustic  in  action,  and  is  there- 
fore not  to  be  employed  in  any  way  as  a  stimulant,  unless  first  diluted. 
The  following  preparations  are  commonly  employed: 

Aqua  Ammonise.  Water  of  Ammonia.  Contains  10  per  cent,  by 
weight  of  the  gas  in  solution  in  water. 

Spiritus  Ammonise.  Spirit  of  Ammonia.  Contains  10  per  cent,  by 
weight  of  the  gas  in  solution  in  alcohol. 

Spiritus  Ammonise  Aromaticus.  Aromatic  Spirit  of  Ammonia.  The 
formula*  of  this  gives  us  a  preparation  whose  stimulant  action,  when 
given  by  the  stomach,  is  of  longer  duration  than  that  of  any  other.  This 
is  because  of  the  gradual  decomposition  of  the  ammonium  carbonate, 
which  thus  liberates  ammonia  gas  for  some  time.  All  of  the  ammonia 
preparations  require  dilution  for  internal  administration.  They  deteri- 
orate with  keeping.  Of  the  salts  of  ammonium  the  following  is  a  valuable 
stimulant : 

*  Aromatic  spirit  of  ammonia  contains :  Water  of  ammonia,  9  per  cent. ;  carbonate 
of  ammonimn,  3.4  per  cent.,  and  small  quantities  of  oils  of  lemon,  lavender  and 
nutmeg,  with  alcohol,  70  per  cent. 


STIMULANTS  AND   TONICS  199 

Ammonii  Carbonas.  Carbonate  of  Ammonium  [NH^HCOg.NH^NHg- 
CO2].  The  stimulating  value  of  this  salt  depends  upon  its  liberation  of 
ammonia  gas,  of  which  it  should  yield  at  least  31.5  per  cent.  When 
exposed  to  the  air  this  readily  occurs,  rendering  the  surface  of  the  crys- 
talline mass  opaque  and  useless.  This  should  be  removed  and  only 
the  translucent  inner  part  of  the  crystal  used,  A  solution  of  the  salt 
given  by  the  stomach  liberates  the  gas  for  some  time,  which  makes 
it  a  very  valuable  diffusible  stimulant,  being  the  most  permanent  in 
action  of  all  agents  of  the  group.  It  enters  into  the  composition  of 
aromatic  spirit  of  ammonia. 

Miscellaneous  Stimulants. 

Various  other  volatile  substances  have  a  stimulant  action  that  is  more 
essential  and  direct,  the  reflex  factor  being  much  less  because  they  are 
less  irritating.  The  volatile  oils  and  substances  related  to  them  belong 
to  this  class.  A  few  only  among  them  are  important  enough  to  deserve 
mention.  These  are  stimulating  to  the  central  nervous  system  and  to  the 
heart.  In  large  doses  they  may  depress.  Locally  some  are  irritating, 
while  others  are  sedative.  They  are  much  used  internally  as  carmina- 
tives, i.  e.,  agents  that  relieve  colic  and  cause  expulsion  of  gas  by  relieving 
spasmodic  contraction  of  the  intestines. 

Camphora.  Camphor  [C^^H^^O].  A  stearopten  derived  from  Cinna- 
momum  camphora.  It  occurs  in  white,  translucent,  crystalline  masses, 
which  are  soluble  in  alcohol,  ether,  chloroform,  and  oils,  but  almost 
insoluble  in  water.  It  has  a  strong  odor  and  sharp  aromatic  taste.  It  is 
tough,  but  may  be  powdered  in  the  presence  of  a  little  alcohol.  (For 
preparations  and  doses,  see  Index  of  Drugs.) 

Locally,  camphor  preparations  are  sedative  except  for  the  alcohol 
present  as  the  solvent.  Internally,  it  is  a  general  stimulant  to  the  nervous 
system  and  heart,  but  in  large  doses  it  may  depress  the  brain,  so  as  to 
cause  delirium  or  convulsions.  The  spirit  may  be  inhaled  in  syncope  or 
faintness. 

For  internal  use  the  pure  camphor  in  pill  or  capsule,  the  spirit,  the 
volatile  oil,  or  camphor-water,  may  be  used,  although  the  last  named  is 
a  very  weak  preparation. 

For  local  application  certain  combinations  which  modify  the  action 
of  camphor  are  sometimes  used.  The  basis  for  these  is  the  fact  that 
when  camphor  is  triturated  with  either  phenol,  chloral  hydrate,  menthol 
or  thymol,  the  mixture  becomes  liquid  and  is  suitable  for  external  use. 


200 


GENERAL   REMEDIES 


Of  these,  Camphorated  'phenol  (Camphophenique)   and  Camphorated 
chloral  are  most  frequently  employed. 

Spiritus  Camphorse.  Spirit  of  Camphor.  This  contains  10  per  cent, 
of  camphor  in  solution  in  alcohol. 

Oleum  Teretinthinse.  Oil  of  Turpentine.  While  this  substance  is 
a  useful  stimulant,  its  odor,  taste  and  poisonous  quality  prevent  its 
common  use  for  this  purpose. 

Oleum  Menthse  Piperitse.  Oil  of  Peppermint.  This  is  used  mostly 
as  a  carminative,  either  in  form  of  the  spirit,  or  combined  with  cathartics 
to  prevent  griping.     The  local  effect  is  sedative. 

Heat.  The  stimulant  effect  of  heat  is  made  use  of  in  various  ways. 
In  case  of  shock  or  collapse  a  hot-water  bag  placed  directly  over  the 
heart,  or  heat  applied  to  the  extremities,  will  be  found  useful.  Copious 
injections  of  very  warm  water,  or  preferably  warm  normal  salt  solution, 
into  the  rectum  and  colon,  is  a  very  excellent  means  of  stimulation  by 
heat.    The  restorative  value  of  the  salt  is  also  here  apparent. 

Normal  Saline  Solution  (0.6  per  cent,  of  sodium  chloride  in  sterile  water) 
used  by  hypodermoclysis,  or  intravenously,  should  be  regarded  to-day 
as  one  of  the  most  important  means  of  stimulation.  It  is  rather 
restoration,  by  a  fluid  corresponding  closely  in  salinity  to  the  blood 
serum,  which  may  be  deficient  or  improperly  distributed.  Loss  of  blood 
by  hemorrhage  or  loss  of  serum  by  a  serous  diarrhea,  would  especially 
indicate  the  use  of  saline  solution.  It  is  also  useful  in  any  condition  of 
extreme  depression.  In  severe  cases  of  typhoid  fever  and  other  exhaust- 
ing diseases,  the  patient  is  oftentimes  tided  over  a  critical  period  which 
might  otherwise  be  fatal,  by  the  daily  use  of  one  to  four  pints  of  normal 
salt  solution  hypodermically.  The  solution  is  prepared  quite  hot  and 
allowed  to  run  slowly  through  a  large- sized,  long  hypodermic  needle  from 
a  fountain  syringe  into  the  lumbar  region  or  underneath  the  breast. 
Other  stimulants  may  be  added  to  the  solution. 

Coca.  The  leaves  of  Erythroxylon  coca  or  of  E.  Truxillense.  By 
referring  to  Plate  II.  it  will  be  seen  that  coca  (or  cocaine)  has  a  general 
stimulant  action  when  given  in  small  doses.  Practically  it  is  seldom 
employed  as  a  stimulant  for  several  reasons — it  is  poisonous,  its  action 
is  uncertain,  as  depressing  effects  may  occur  early  from  it,  and  there  is 
great  danger  of  acquiring  the  habit  of  using  it.  About  the  only  place  of 
usefulness  that  it  occupies  as  a  stimulant  is  with  old  people,  where  the 
cerebral  and  circulatory  functions  are  failing  and  the  danger  of  forma- 
tion of  habit  is  slight.  The  fluid  extract  of  coca  is  the  preparation  most 
useful.    The  indiscriminate  use  of  "wine  of  coca"  is  to  be  condemned. 


PLATE  IX. 

BELLADONNA. 

Leaves  and  root  of  Atropa  B.     The  alkaloid  Atropine  represents  the  drug  fully. 
[For  preparations  and  doses,  see  Index  of  Drugs.] 

Classified  as : 

Cerebral  stimulant.  Deliriant  narcotic.  Mydriatic. 

Cardiac  stimulant.  Anodyne.  Antihidrotic. 

Physiologic  action  : 

In  general,  '•  atropine  acts  as  a  stimulant  to  the  central  nervous  system  and  paralyzes  the 
terminations  of  a  number  of  the  nerves,  more  especially  of  those  that  supply  invol- 
untary muscle,  secretory  glands  and  the  heart."  [Cushny.]  It  paralyzes  peripheral 
inhibition.  It  decreases  the  secretions  generally,  except  the  urine,  and  increases  the 
body  tempei-ature,  producing  a  condition  simulating  fever. 

Nervous  System.. 

Brain.     Stimulates  the  cerebrum,  especially  in  its  motor  areas. 
M^eduUa.     Stimulates  respiratory  and  vasomotor  centers. 
Spinal  cord.     Depresses  inhibitory  centei-s. 

Nerves. 

Sensory.     Depresses  sensory  nerve  endings. 

Motor.     Depresses  motor  nerves. 

Secretory.  Paralyzes  the  endings  of  many  of  the  secretory  nerves,  causing  a  diminu- 
tion or  arrest  of  the  secretion ;  hence  there  result  dryness  of  the  mouth,  lessened 
secretion  of  gastric  and  pancreatic  juices  and  of  milk.  The  sweat  glands  are  rendered 
less  active. 

Vagus.     Paralyzes  the  inhibitory  terminations  of  the  vagus  within  the  heart,  and  the 
secretory  terminations  within  the  digestive  system. 
Muscular  System.     Depresses  unstriped   muscle,  but   has   no   influence   upon    voluntary 
muscle.     Lessens  the  movements  of  stomach,  hitestines,  bladder,  uterus,  and  in  gen- 
eral the  organs  containing  unstriped  muscle,  except  the  arterial  walls.     [Cushky.] 

Eye.     Pupils  are  dila,ted  by  paralysis  of  terminals  of  the  motor  oculi  nerve  in  the  iris, 

with  possible  stimulation  of  the  sympathetic  terminals.     It  paralyzes  accommodation. 

Most  authorities  state  that  it  increases  inti-aocular  pressure. 
Circulation.     Arterial  pressure  is  increased,  chiefly  by  central  vasomotor  stimulation. 
Heart.     Increases  pulse  rate  by  paralyzing  inhibition   (peripheral  ends  of   vagus). 

The  heart  muscle  or  its  accelerator  nerves  may  feebly  be  stimulated. 
Capillary  area.     Arterioles  are  contracted. 
Respiration.     Stimulated  by  action  upon  respiratory  center. 
Excretion.     Perspiration  is  lessened.     The  drug  is  excreted  rapidly  by  the  kidneys,  but 

its  influence  upon  their  activity  is  uncertain. 


PLATE    IX. 


Sweat  glands 
lesn  active 
Motor  nerves 
and  sensory 
yierve  endings 
depressed. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


Pelvic  Plexus 


The  red  color  indicates  stimulation,  and  the  blue  color  depression. 


CAFFEINE. 

An  alkaloid  existing  in  coflFee, 
tea,  guarana,  and  cola  nut. 

[For  preparations  and  doses,  see 
Index  of  Drugs.] 

Classified  as : 

Cerebral  stimulant. 
Cardiac  stimulant. 
Respiratory  stimulant. 
Diuretic. 

Physiologic  action : 

Nervous  System. 

Cerebrum.  Stimulates 
cortex,  increasing  the  ac- 
tivity of  psychic  func- 
tions. 

Medulla.  Stimulates  res- 
piratory center  and  vaso- 
motor center.  Vagus  cen- 
ter may  be  stimulated, 
but  the  effect  masked  by 
the  direct  effect  upon  the 
heart. 


PLATE    X. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Symioathetic 


Voluntary 
Muscle 


Solar  Plexus 


Muscular  System.      Irritability   and   working  power  of   muscle 
tissue  increased. 

Circulation.     Arterial  pressure  increased  by  vasomotor  activity. 

Heart.  Stimulates  heart  muscle,  jiroducing  acceleration  of 
the  pulse. 

Capillary  area.  Contracts  arterioles  by  stimulation  of  vaso- 
motor center  in  the  medulla,  and  probably  also  by  direct 
action  upon  the  constrictor  fibers  in  the  vessel  walls. 

Excretion. 

Kidneys.  Stimulates  excretory  function,  both  of  the  glom- 
eruli and  the  renal  epithelium,  causing  increase  of  water 
and  of  solids,  the  increase  of  water  being  more  marked. 
The  diuretic  effect  may  be  prevented  by  the  vasomotor 
action. 


The  red  color  indicates  stimulation 
by  Caffeine. 


STIMULANTS  AXD    TOXICS  201 

Belladonna — Atropina  [C^-HjaNOg].     (Plate  IX.) 

BelladonnoB  Folia.  Belladonnos  Radix.  This  drug  holds  a  unique 
place  as  being  a  central  stimulant  and  peripheral  depressant  to  the 
nervous  system.  Either  the  alkaloid  atropine  or  the  tincture  of  bella- 
donna may  be  used  as  a  general  and  cardiac  stimulant,  atropine  being 
always  preferred  for  hypodermic  use.  But  this  drug  must  be  regarded 
as  a  second-rate  stimulant^  and  care  must  be  taken  not  to  exceed  the 
physiologic  limit,  as  it  may  then  be  disturbing  or  narcotic  in  effect. 
Locally  applied,  belladonna  is  anodyne,  acting  by  depressing  sensory 
nerve  endings.  It  is  used  to  allay  local  pain  or  irritation,  as  in  neu- 
ralgia, for  which  purpose  the  plaster,  ointment,  or  liniment  of  bella- 
donna, or  the  oleate  of  atropine  may  be  applied.  (For  preparations 
and  doses,  see  Index  of  Drugs.) 

Atropine  in  aqueous  solution  is  dropped  into  the  eye  to  dilate  the  pupil. 
Any  preparation  of  belladonna  or  atropine  promptly  checks  the  excessive 
flow  of  saliva  in  mercurialism,  for  the  treatment  of  which  symptom  it 
is  our  best  agent.  Sweating  is  also  diminished  by  this  drug,  as  are  also 
various  other  secretions  of  the  body.  In  checking  secretion  the  drug 
acts  by  paralyzing  the  secretory  nerve  terminals  within  the  glands. 

The  official  salt  of  the  alkaloid  is  Atropinae  sulphas. 

The  following  alkaloids  have  an  action  somewhat  similar  to  that  of 
atropine : 

Homatropinse  Hydrobromidum,  an  artificial  alkaloid,  is  used  as  a 
mydriatic,  producing  a  more  rapid  and  more  transient  dilatation  of  the 
pupil  than  does  atropine.    It  is  used  locally.     (See  Index  of  Drugs.) 

Hyoscyaminae  Hydrobromidum, 

HyoscinaB    Hydrobromidum,     both     from    Hyoscyamus    leaves,    and 

Scopolaminae  Hydrobromidum,  from  Scopola  root,  are  less  stimulating 
than  atropine  to  the  central  nervous  system,  and  more  hypnotic  and 
sedative.     (See  Index  of  Drugs.) 

Caffeina.    Caffeine  [CgH.oNp^+Hp].     (Plate  X.) 

Caffeina  Citrata.  Citrated  Caffeine.  This  alkaloid,  obtained  from 
tea  and  coffee,  has  an  important  use  as  a  heart  and  cerebral  stimulant 
and  as  a  diuretic.  It  is  entirely  safe  to  be  used  in  large  doses,  therefore 
it  is  one  of  the  best  stimulants  to  employ  in  poisoning  by  narcotics.  The 
citrated  caffeine  is  the  preparation  usually  employed,  because  more 
soluble  than  caffeine.     (See  note  on  p.  165.) 


202  GENERAL  REMEDIES 

Theobromine  (from  Theohroma  cacao  and  from  Guarana)  has  an  action 
upon  the  circulation  similar  to  that  of  caffeine,  but  is  superior  as  a 
diuretic,  and  less  stimulating  to  the  cerebrum.     (Not  official.) 

Nux  Vomica— Strychnina  [C21H22N2O2].      (Plate  XI.) 

(For  preparations  and  doses,  see  Index  of  Drugs.) 

This  drug  easily  ranks  as  one  of  the  very  best  general  stimulants.  In 
large  doses  it  is  poisonous,  but  it  is  not  narcotic,  therefore  it  can  be 
pushed  to  its  physiologic  limit  with  less  danger  than  is  the  case  with 
belladonna.  It  increases  the  irritability  of  nerve  centres  to  normal 
stimuli,  and  does  not  tend  directly  to  exhaustion.  It  is  a  valuable 
respiratory  stimulant  by  action  upon  the  centres. 

In  all  conditions  of  general  depression,  cardiac  weakness,  in  infectious 
diseases,  pneumonia,  typhoid  fever,  in  poisoning  by  cocaine,  opium  and 
other  narcotics,  it  is  useful.    It  is  also  used  as  a  stomachic  tonic. 

Internally  any  preparation  may  be  given.  Hypodermically  a  salt  of 
the  alkaloid  strychnine  is  employed.  The  official  salts  of  strychnine 
are: 

Strychninse  Nitras. 

Strychninse  Sulphas. 

(For  symptoms  and  treatment  of  poisoning  by  strychnine,  see  Table 
of  Poisons  and  Antidotes.) 

Digitalis.    (Plate  XII.) 

(For  preparations  and  doses,  see  Index  of  Drugs.) 
Digitalis  is  used  whenever  the  heart  is  unequal  to  its  task,  by  reason 
of  valvular  disease  or  simple  weakness.  When  extensive  fatty  degenera- 
tion is  present,  and  in  certain  valvular  defects,  it  is  not  the  drug  of  choice, 
but  may  be  required.  As  it  "whips  up"  the  heart  to  greater  exertion,  its 
use  should  be  discontinued  as  soon  as  possible,  so  as  to  avoid  exliaustion 
of  the  organ.  It  should  be  regarded  as  an  emergency  drug  in  cardiac 
diseases. 

The  vasoconstrictor  action  is  sometimes  objectionable,  in  which  case 
it  may  be  overcome  by  combining  it  with  nitroglycerin.  When  cardiac 
disease  is  fully  compensated,  and  in  simple  hypertrophy,  digitalis  should 
not  be  used.  When  arterial  pressure  is  high  the  drug  is  not  indicated. 
In  these  conditions  the  drug  may  do  harm.  The  tincture  and  the  infusion 
are  the  preparations  mostly  employed.  In  emergency  the  tincture 
may  be  used  hypodermically  in  full  dose.  The  drug  acts  slowly,  and  it 
therefore  cannot  be  relied  upon  alone  as  an  emergency  stimulant. 


PLATE    XI. 


NUX  VOMICA. 

The  seeds  of  Strychnos  Nux  V. 

The  alkaloid  Strychnine  repre- 
sents the  drug  fully. 
[For  preparations  and  doses,  see 
Index  of  Drugs.] 


Classified  as : 

Bitter  tonic. 
Cardiac  stimulant. 
Nerve  stimulant. 
Excitomotor. 

Physiologic  action  : 

Digestive  Tract.  Stimulates  se- 
cretion of  gastric  juice 
and  motility  of  stomach. 

Nervous  System. 

Cerebrum.  No  effect  upon 

cortex.    Consciousness  not 

influenced.    Special  senses 

rendered  more  acute. 
Medulla.     Stimulates  i-es- 

piratory    and     vasomotor 

centers.   Vagus  center  may 

be  slightly  stimulated. 
Spinal  cord.     Increases  reflex  irritability  of  the  cord  in  its 

whole  extent. 

Circulation.     Arterial  pressure  increased. 
Heart.     It  is  believed  to  stimulate  either  heart  muscle  or 

cardiac  ganglia,  or  both. 
Capillary  area.      Arterioles  are  contracted  by  its  action 

upon  vasomotor  centers  of  medulla  and  cord. 

Excretion.  Eliminated  by  the  kidneys,  appearing  soon  after  ab- 
sorption, partly  unchanged  and  pai'tly  changed.  Contraction 
of  renal  vessels  may  hinder  its  elimination. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


Solar  Plexus 


The  red  color  indicates  the 
stimulant  action  of  Nux 
Vomica  or  Strj'chni7ie. 


PLATE    XII. 


DIGITALIS. 

The  leaves  of  D.  Purpurea  of  the 

second  year's  growth. 

[For  preparations  and  doses,  see 

Index  of  Drugs.] 

Note. — The  description  below 

is  of  tlie  action  of  the  drug  or  of 

preparations  fully  representing  it. 

Classified  as : 
Cardiac  stimulant. 
Cardiac  tonic. 
Vasoconstri  ctor . 
Diuretic. 

Physiologic  action  : 

Stomach.  Absorbed  slowly. 
Irritant  in  large  doses  or 
when  long  continued. 

Nervous  System. 

Brain.     No  influence  upon 

the  cerebrum. 
Medulla.     Stimulates  vasomotor  and  vagus  centers. 

Muscular  System.     Stimulates  directly  the  constrictor  fibers  of 

the  arterioles. 
Circulation.     Gives  greater  force  and  rapidity  to  arterial  current, 

with  higher  blood-pressure. 
Heart.     Stimulates  the  inhibitory  influence  (vagus,  center 

and  periphery),  which  slows  the  heart  and  tends  toward 

relaxation.     Stimulates  the  cardiac  muscle  and  contained 

ganglia,  giving  greater  force  to  the  contractions. 
Capillary  area.    Arterioles  contracted  both  by  direct  local 

action  and  by  stimulation  of   the  vasomotor  center  in  the 

medulla. 

Excretion. 
Kidneys.    Direct  action  upon  the  renal  epithelium  is  uncer- 
tain.    The  urine  is  increased,  but  mainly  through  the  in- 
fluence of  higher  arterial  pressure. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


Solar  Plexus 


The  red  color  indicates  the 
stimulant  action  of  Digitalis. 


PLATE    XIII. 
ZS^ITRITES. 

Amyl  Nitrite, 

IfTL  1-5  (Gm.  .06-.30). 
Nitroglycerin  {Glonoin,  Trini- 
ty in). 

gi'-T*Wo(Gm.  .0005-.001). 

Spiritxjs  Glycerylis  Nitra- 

Tis,  1  per  cent.  Nitroglycerin. 

1TL  ^2  (Gm.  .03-.12). 

Sodium  Nitrite, 

gr.  1-3  (Gm.  .06-.20). 

Classified  as  : 

Vasodilators. 
Circulatory  stimulants. 

Physiologic  action : 

While  the  action  of  the  sev- 
eral drugs  of  this  group  is  very  similar,  Amyl  Nitrite 
(by  inhalation)  lias  the  most  rapid  and  transient  effect. 
Nitroglycerin  is  most  powerful,  and  Sodium  Nitrite 
has  the  most  permanent  effect. 

Nervous  System. 

Brain.     No  direct  influence  upon  cerebrum. 
Medulla.     Depresses  vagus  center. 
Muscular  System.     Paralyzes  the  muscular  coats  of  the  arterioles. 
Circulation.     Causes  a  decided  fall  in  arterial  pressure  with  accel- 
eration of  the  pulse. 
Heart.     Any  direct  action  upon  the  heart  is  doubtful.     The 
acceleration  is  due  mainly  to  depression  of  the  vagus  center. 
Capillary  area.     Dilates  arterioles,  thereby  increasing  the 

volume  and  efficiency  of  the  capillary  circulation. 
The  influence  upon  arterial  pressure  and  pulse  rate  is  shown  by 
the  following  sphygmographic  pulse  tracings : 


Vagus  Centei 

Vase  Motor 

Center 
Cervical 
Symjoathetio 


Solar  Plexus 


Normal  pulse  tracing.     Eate  84 ;  blood  pressure  normal 


The  same  after  taking  Nitroglycerin.     Eate  96  ;  blood  pressure 
greatly  reduced. 

The  red  color  indicates  the  stimulant  effects  of  the  nitrites ;  the 
blue  color  indicates  their  depressant  action  upon  the  vagus 
center,  which  is  the  chief  cause  of  the  increase  in  pulse  rate. 

Note.— The  blood  changes  produced  in -animals  by  Amyl  Nitrite  are  not  seen  in  man  fol- 
lowing therapeutic  dosage. 


STIMULANTS  AND  TONICS  203 

The  drugs  of  the  following  group  each  have  an  action  similar  to  that 
of  digitalis  and  may  be  used  as  substitutes  for  it.  Squill,  in  addition, 
is  expectorant  and  more  decidedly  diuretic. 

Convallaria.     Lily  of  the  Valley. 

Scilla.    Squill. 

Strophanthus. 

(For  preparations  and  doses,  see  Index  of  Drugs.) 

Nitrites.     (Plate  XIII.) 

The  nitrites  are  indicated  in  conditions  of  high  arterial  pressure,  due 
to  disease  of  the  arteries  or  constriction  of  arterioles.  It  cannot  be 
regarded  as  a  direct  heart  stimulant  of  any  decided  power,  but  it  acts 
in  an  equivalent  way,  by  reducing  the  work  of  the  heart  through  dilating 
the  arterioles.  In  this  way  the  resistance  against  which  the  heart  has 
to  force  the  blood  is  largely  removed,  and  at  the  same  time  the  capil- 
lary circulation  is  much  freer.  By  depression  of  the  vagus  inhibitory 
centre,  these  drugs  also  allow  greater  rapidity  of  the  heart's  action. 
Nitrites  should  not  be  used  in  conditions  of  low  arterial  pressure. 
Nitroglycerin  in  tablet  form,  or  in  the  1  per  cent,  solution  (Spiritus 
Glycerylis  Nitratis)  is  commonly  employed.  It  is  the  best  representa- 
tive of  the  group  of  nitrites. 

It  is  not  necessary  to  give  nitrites  hypodermically,  as  the  effect  of 
amyl  nitrite  may  be  obtained  almost  instantly  by  inhalation,  and  a  dose 
of  nitroglycerin  placed  under  the  tongue  will  produce  its  full  effect  in 
from  three  to  five  minutes.  Its  action  also  completely  disappears  in 
from  thirty  to  sixty  minutes.  When  the  drug  is  really  indicated  it  may 
be  given  every  hour  for  several  doses  if  necessary,  or  the  dose  may  be 
increased  as  needed  up  to  gr.  -^-^  (0.001  gm.)  or  more. 

In  conditions  that  are  believed  to  be  due  to  arterial  spasm  or  con- 
striction, as  angina  pectoris  and  asthma,  the  nitrites  are  useful  for 
temporary  relief ;  and  in  arteriosclerosis  they  sometimes  constitute  the 
principal  medicinal  treatment. 

It  may  be  said  to-day  that  the  value  of  the  nitrites  has  been  over- 
estimated. Upon  the  plain  indications  mentioned  above  they  occupy 
a  place  of  usefulness  that  is  their  own,  no  other  drugs  being  comparable 
to  them;  but  it  is  unfortunate  that  the  belief  has  become  current  that 
they  are  direct  heart  stimulants.  For,  with  this  belief  as  a  basis,  they 
are  quite  extensively  used  in  such  diseases  as  pneumonia  and  other  acute 
infectious  diseases,  where  the  blood  pressure  is  already  too  low  to  allow 
efficiency  of  circulation,  and  in  cases  of  chloroform  narcosis,  where  the 


204  GENERAL   REMEDIES 

same  condition  prevails.  In  fact,  it  is  the  practice  of  some,  the  more 
cardiac  stimulation  is  needed,  the  more  to  resort  to  the  nitrites;  while 
it  is  true  in  the  main  that  the  more  cardiac  stimulation  is  needed  the 
less  are  the  nitrites  indicated.  Cardiac  stimulation  is  seldom  needed 
unless  the  arterial  pressure  is  low,  and  a  drug  that  will  tend  to  reduce  it 
still  farther  is  certainly  contraindicated,  unless  in  combination  with  a 
true  heart  stimulant  such  as  digitalis.  Therefore,  the  real  indications 
for  the  nitrites  are  found  in  the  arterial  system  rather  than  in  the  heart, 
and  they  consist  of  peripheral  arterial  spasm,  or  of  more  permanent 
constriction  due  to  disease  of  the  arterial  walls,  or  of  the  natural  loss  of 
elasticity  in  the  arterial  system  that  occurs  with  age.  In  either  condition 
the  heart  is  not  likely  to  need  any  stimulation,  unless  degeneration  has 
occurred  or  its  nutrition  is  disturbed.  The  nitrites,  therefore,  should  be 
viewed  as  vasodilators,  not  as  heart  stimulants.  But  in  their  action  as 
vasodilators  they  may  be  regarded  as  circulatory  stimulants.  The 
capillary  area  fed  by  the  arterioles  is,  after  all,  the  most  important  part 
of  the  circulation,  for  it  is  there,  in  the  cells  of  the  tissues,  that  all  nutritive 
changes  occur  and  all  functional  activity  is  maintained. 

In  conditions  of  high  arterial  pressure,  the  blood  supply  to  the  capil- 
laries is  often  lessened  by  the  tendency  to  constriction  of  the  arterioles 
that  is  present.  The  nitrites,  by  dilating  the  arterioles,  will  increase  the 
blood  supply  to  the  capillary  area  and  furnish  better  nutritive  materials 
for  cell  activity — a  true  circulatory  stimulation,  but  not  heart  stimulation 
— an  efficient  heart  action  being  a  prerequisite. 

It  is  worthy  of  note  that,  whatever  the  beneficial  result,  the  physiologic 
action  of  the  nitrites  is  chiefly  depressant  upon  vagus  centres  and  upon 
vasoconstrictor  muscle  tissue  in  the  arterioles. 

TONICS. 

Tonics  are  frequently  defined  as  permanent  stimulants.  This  conveys 
the  idea  of  permanency  of  result  which  always  pertains  to  the  class,  but 
we  must  note  that  tonics  may  not  have  any  proper  stimulating  action. 
It  is  difficult  to  form  a  definition  that  will  include  all  remedies  of  the 
class,  because  of  the  wide  difference  in  their  nature  and  action.  Their 
chief  value  is  in  relation  to  the  reserve  energy  of  organs,  which  they 
conserve  by  supplying  the  necessary  materials  for  tissue  renovation  and 
for  the  production  of  energy,. or  by  otherwise  promoting  nutrition.  Iron 
is  classed  as  a  restorative  tonic  for  the  reason  that  it  supplies  a  normal 
constituent  to  the  blood  and  tissues.    The  ordinary  foods  hold  a  similar 


STIMULANTS  AND   TONICS  205 

place  and  must  be  regarded  as  tonics  in  the  sense  that  they  restore 
needed  materiaL  On  the  other  hand,  bathing  and  massage  will  promote 
the  general  nutrition  of  the  body,  and  are,  therefore,  tonic  remedies. 
The  simple  bitters,  such  as  gentian,  taken  into  the  stomach,  stimulate 
the  digestive  functions  and  thus  indirectly  promote  general  nutrition. 

A  simple  classification  which  will  aid  our  study  of  these  substances, 
may  be  made  as  follows: 

Nutritional  Tonics — those  that  promote  the  general  processes  of 
nutrition. 

Examples:     Bitter  tonics,  bathing,  and  massage. 

Restorative  Tonics — those  that  supply  material  for  tissue  reconstruction 
or  energy  production. 

Examples:     Iron,  foods,  and  phosphorus. 

Nutritional  Tonics. 

Among  the  class  of  nutritional  tonics — i.  e.,  those  that  promote  the 
general  processes  of  nutrition — are  those  that  act  by  increasing  the 
activity  of  digestion.  These  are  known  as  stomachic  tonics  or  simple 
hitters.  Their  chief  characteristic  is  their  bitterness,  by  which  they 
seem  to  stimulate,  possibly  through  primary  irritation,  the  mucous 
membrane  and  secretory  glands  of  the  stomach.  The  immediate  result 
of  their  presence  in  the  stomach  is  to  retard  or  lessen  secretion,  but  this 
is  soon  succeeded  by  an  increase  of  secretion,  so  that  the  full  effect, 
obtained  fifteen  to  thirty  minutes  after  administration,  is  an  increase  of 
gastric  juice  and  of  motility  of  the  stomach.  They  should  be  given 
before  meals  so  that  their  full  action  may  be  secured  in  time  for  the 
beginning  of  stomach  digestion.  The  chief  agents  of  this  character  are 
here  given,     (For  preparations  and  doses,  see  Index  of  Drugs.) 

Simple  Bitters. 

Calumba.     Columbo.     The  root  of  Jateorrhiza  palmata. 

Gentiana.     Gentian.     The  root  of  Gentiana  lutea. 

Quassia.     The  wood  of  Picrasma  excelsa  or  of  Quassia  amara. 

Of  any  of  these  the  tincture  (in  case  of  gentian  the  compound  tincture) 
is  a  leading  preparation  and  may  be  given,  in  case  of  each,  in  a  dose  of 
f5j-iv  (4-15  c.c).  The  infusion  of  quassia  is  easily  prepared  with  cold 
water,  and  may  be  given  freely. 

To  this  group  of  simple  bitters  must  be  added  several  other  drugs  that 
are  equally  efficient  as  stomachics,  but  whose  more  important  action 
gives  them  a  larger  place.    They  are  sometimes  called; 


206  GENERAL  REMEDIES 

Peculiar  Bitters. 

Cinchona.  Peruvian  Bark.  The  bark  of  a  number  of  species  of 
cinchona.  It  contains  quinine  and  many  other  alkaloids.  (For  prep- 
arations and  doses,  see  Index  of  Drugs.)  Quinine  represents  the  drug 
fully.     (For  its  combinations  and  doses,  see  Index  of  Drugs.) 

Besides  being  a  bitter  tonic,  quinine  is  an  efficient  antiseptic,  but  its 
bitterness  prevents  its  extensive  internal  use  as  such ;  although  it  is  some- 
times employed  as  an  intestinal  antiseptic.  Its  cost  also  is  somewhat 
prohibitive  of  general  use  as  an  antiseptic.  Its  most  valuable  and  dis- 
tinctive use  is  in  malarial  fever  (fever  and  ague),  in  which  disease  it  is  a 
specific,  preventing  in  the  blood  the  growth  of  the  plasmodium  malarise, 
upon  which  the  disease  depends.  This  must  be  regarded  as  a  true 
antiseptic  action.  It  is  obtained  after  absorption  of  the  drug,  which  for 
this  purpose  is  given  in  full  dose  of  15  to  30  grains  (1-2  gm.)  daily,  in 
single  or  divided  doses.  A  favorite  method  is  to  give  15  grains  (1  gm.) 
in  one  dose  daily,  about  three  hours  before  the  expected  paroxysm. 

A  form  of  supraorbital  neuralgia  supposed  to  be  of  malarial  origin, 
known  as  brow  ague,  which  presents  the  periodic  character  of  malarial 
fever,  in  that  it  usually  occurs  at  about  the  same  hour  each  day,  or 
every  second  day,  continues  with  severity  for  some  hours  and  then 
disappears,  is  promptly  relieved  by  a  full  dose  of  quinine  daily,  three 
hours  before  the  usual  time  of  its  onset. 

Quinine  sulphate  is  the  salt  mostly  employed,  but  it  is  only  slightly 
soluble  in  water  except  when  an  acid  is  added.  The  bisulphate  is  freely 
soluble.  With  the  giving  of  large  doses  of  quinine  there  occur  the 
evidences  of  saturation,  that  are  known  as  cinchonism.  Ringing  in  the 
ears  and  fulness  of  the  head  are  the  symptoms  of  this  condition,  which 
is  not  serious,  but  passes  away  soon  after  cessation  of  the  drug.  Quinine 
is  used  much  less  now  than  it  was  in  former  years,  before  its  precise 
action  and  its  limitations  were  understood.  In  large  doses  it  has  been 
supposed  to  be  antiphlogistic — combating  inflammation.  This  belief 
was  supported  by  the  fact  that  quinine  may  be  seen,  under  the  micro- 
scope, to  possess  the  power  of  checking  the  ameboid  movements  of 
leukocytes.  However  well  founded  its  reputation  in  this  direction  has 
been,  we  see  to-day  that  its  use  has  declined  somewhat,  except  as  a 
bitter  tonic  and  in  the  treatment  of  malarial  fevers ;  nor  are  very  large 
doses  now  given,  as  was  formerly  the  practice. 

Nux  Vomica.  The  seeds  of  Strychnos  Nux-vomica,  containing  not  less 
than  1.25  per  cent,  of  strychnine.  (For  preparations  and  doses,  see 
Index  of  Drugs.)     The  representative  alkaloid,  strychnine,  has  been 


STIMULANTS  AND   TONICS  207 

fully  considered  as  a  stimulant.  It  is  valuable  also  as  a  bitter  tonic,  as 
are  the  preparations  of  nux  vomica.  All  preparations  are  intensely  and 
persistently  bitter.  The  special  value  of  this  drug,  in  its  general  tonic 
use,  lies  in  the  fact  that,  after  its  local  effect  in  the  stomach,  its  absorption 
is  followed  by  a  general  increase  in  the  activity  of  all  reflexes,  through 
its  action  upon  nerve  centres  of  reflex  action.  This  is  the  effect  that 
pertains  to  the  action  of  the  alkaloid  strychnine  in  its  use  as  a  stimulant. 
The  tincture  of  nux  vomica  is  the  preparation  most  commonly  used  as  a 
bitter  tonic.  In  large  doses  the  drug  is  poisonous,  causing  very  char- 
acteristic tonic  convulsions  which  affect  chiefly  the  muscles  whose  nerve 
supply  is  directly  from  the  spinal  cord.  (See  Table  of  Poisons  and 
Antidotes.) 

Pninus  Virginiana.  Wild  Cherry.  The  bark  of  Prunus  serotina, 
gathered  in  the  autumn.  (For  preparations  and  doses,  see  Index  of 
Drugs.)  In  addition  to  its  action  as  a  stomachic  tonic,  this  drug  possesses 
decided  sedative  properties,  which  are  due  to  the  presence  of  hydrocyanic 
acid  in  its  preparations.  This  substance  does  not  exist  in  the  crude  drug, 
but  is  developed  when  the  latter  is  treated  with  cold  water.  By  a 
reaction  between  two  constituents,  amygdalin  and  emulsin,  a.  volatile 
oil  identical  with  oil  of  bitter  almond  is  formed.  This  contains  hydro- 
cyanic acid.  Wild  cherry  finds  its  special  use  where  a  general  or  local 
nerve  sedative  is  indicated,  in  connection  with  a  stomachic  tonic.  In 
cough  mixtures  its  preparations  fill  a  useful  place.  Its  local  sedative 
and  tonic  effects  make  it  a  remedy  that  is  applicable  in  irritable  con- 
ditions of  the  stomach,  to  control  vomiting  and  improve  digestion. 

Restorative  Tonics. 

This  class  comprises  both  the  ordinary  food  substances,  that  supply 
material  for  tissue  reconstruction  and  energy  production,  and  the 
medicinal  agents  that  are  really  foods  in  the  sense  that  they  are  necessary 
to  the  tissues,  but  which  may  be  supplied  in  pure  or  special  forms  aside 
from  food. 

Passing  the  ordinary  food  substances  with  the  simple  mention  of 
oxygen,  water,  starchy,  fatty  and  nitrogenous  foods  and  sodium  chloride, 
our  chief  consideration  will  be  given  to  the  restoratives  ordinarily 
regarded  as  medicines.  Inasmuch  as  they  aid  chiefly  by  restoring  some 
element  that  is  lacking,  their  precise  action  requires  no  extended  dis- 
cussion. We  are  more  concerned  with  the  form  or  combination  of  the 
drug  in  order  to  pleasant  administration  and  ready  assimilation. 


208  GENERAL   REMEDIES 

Ferrum.  Iron  [Fe].  (For  preparations,  their  reactions  and  doses, 
see  Index  of  Drugs.)  This  metal  is  commonly  employed  either  in  its 
pure  form  of  reduced  iron  or  in  one  of  its  many  combinations.  The 
large  number  of  these  supply  every  need  of  form,  and  of  adaptability  to 
the  various  conditions  that  call  for  its  use.  Those  most  frequently  used 
are  ferrum  reductum,  massa  ferri  carbonatis,  ferri  pyrophoephas, 
tinctura  ferri  chloridi,  and  syrupus  ferri  iodidi.  The  last-named  is 
alterative  as  well  as  restorative,  and  a  most  useful  agent  in  the  treatment 
of  so-called  scrofulous  conditions  in  children. 

Besides  these  preparations  the  great  variety  of  compound  salts  find 
special  uses.  Ferri  hydroxidum  and  jerri  hydroxidum  cum  magnesii 
oxido  are  the  most  useful  chemical  antidotes  to  arsenic.  The  real 
systemic  action  of  iron  is  always  in  the  blood,  and  whatever  salt  or  com- 
bination is  employed  the  iron  is  believed  to  be  changed  to  the  chloride 
before  absorption.  It  furnishes  material  for  the  coloring  matter  of  the 
red  cells,  therefore  it  is  especially  indicated  where  there  is  deficiency  of 
hemoglobin.  Chlorosis  is  the  typical  condition  that  is  usually  promptly 
met  by  iron  in  any  form.  Improvement  in  the  blood  results  in  a  better 
state  of  the  whole  system. 

It  should  be  insisted  that  it  is  entirely  unnecessary  to  use  the  new  and 
largely  advertised  preparations  of  iron.  As  a  rule,  they  are  expensive, 
and  not  at  all  superior  to  the  older  well-known  forms.  The  reaction  of 
iron  salts  should  be  noticed,  and  for  prolonged  use  those  that  are  neutral 
selected  by  preference,  so  as  to  avoid  damage  to  the  teeth.  Only  those 
that  have  an  acid  reaction  can  affect  the  tooth  structure,  but  staining 
may  follow  the  use  of  any  preparation  in  a  mouth  that  is  not  kept 
scrupulously  clean.  This  stain,  which  is  usually  sulphide  of  iron,  may 
be  easily  removed  from  the  surface  of  the  enamel,  but  in  a  cavity  it  may 
be  more  permanent.  The  tincture  of  the  chloride  is  one  of  the  strongly 
acid  preparations  that  must  be  used  with  care.  Its  contact  with  the  teeth 
may  be  limited  by  taking  it  through  a  glass  tube,  but  a  more  positive  safe- 
guard is  to  ensure  neutralization  of  the  acid  by  rinsing  the  mouth,  before 
and  after  taking,  with  a  solution  of  sodium  bicarbonate  or  other  alkali. 

Mineral  Acids.  These  are  used  internally  only  in  the  dilute  form. 
Even  then  they  should  be  further  diluted,  and  the  same  precautions 
taken  to  protect  the  teeth  as  are  mentioned  above. 

Acidum  Hydrochloricum  Dilutum.  Diluted  Hydrochloric  Acid. 
10  per  cent,  by  weight  of  absolute  hydrochloric  acid. 

Acidum  Nitricum  Dilutum.  Diluted  Nitric  Acid.  10  per  cent,  by 
weight  of  absolute  nitric  acid. 


STIMULANTS  AND   TONICS  209 

Acidum  Nitrohydrochloricum  Dilutum.  Diluted  Nitrohtdrochloric 
Acid.     4  per  cent,  nitric  acid  and  18.2  per  cent,  hydrochloric  acid. 

Acidum  Sulphuricum  Dilutum.  Diluted  Sulphuric  Acid.  10  per 
cent,  by  weight  of  absolute  sulphuric  acid. 

[Acidum  Sulphuricum  Aromaticum  contains  20  per  cent,  by  weight  of 
absolute  sulphuric  acid  in  nearly  pure  alcohol]. 

The  dose  of  either  of  these  is  rrL  5-20  (0.30-1.20  gm.).  They  are  given 
after  meals,  as  a  rule.  x\  very  important  use  of  dilute  hydrochloric  acid 
is  to  restore  the  quality  of  the  gastric  juice  when  its  acid  is  deficient.  It 
being  the  normal  acid  of  this  digestive  fluid,  its  administration  furnishes 
one  of  the  most  typical  instances  of  restorative  treatment. 

Vegetable  Acids.    These  include: 

Acidum  Citricum.     Citric  Acid. 

Acidum  Tartaricum.    Tartaric  Acid. 

It  is  not  easy  to  explain  the  action  of  vegetable  acids  upon  the  ground 
of  supplying  normal  elements  that  are  lacking  in  the  system.  But  their 
use  is  established  by  long  clinical  experience  in  certain  conditions  of 
disturbed  nutrition  that  follow  prolonged  abstinence  from  fresh  foods, 
as  with  sailors  upon  long  sea  voyages.  The  disease  induced  is  known 
as  scurvy,  and  it  seems  to  present  an  altered  or  depraved  condition  of 
the  blood  as  its  chief  pathology.  Upon  the  skin  and  mucous  membranes 
more  or  less  extensive  spots  of  ecchymosis  occur,  the  particular  kind  of 
lesion  being  known  as  purpura.  The  abnormal  condition  of  blood  is 
usually  promptly  removed,  with  full  return  of  health,  by  a  free  supply 
of  fresh  fruits,  vegetables,  and  meats.  Citric  acid,  alone  or  as  present 
in  the  juice  of  lemons  or  limes,  is  a  valuable  addition  to  the  dietetic 
treatment  of  scurvy.  Tartaric  acid  is  used  simply  as  a  substitute  for 
citric  acid. 

Phosphorus  [P].  (For  preparations  and  doses,  see  Index  of  Drugs.) 
This  substance  is  of  the  greatest  importance  to  the  system,  in  its 
capacity  as  a  restorative.  Among  other  effects  of  its  prolonged  use,  it 
has  been  shown  to  have  the  power  of  inducing  more  rapid  gro-^th  of 
bone,  as  was  found  to  result  in  experiments  upon  animals.*  Accordingly, 
it  may  be  of  service  in  delayed  dentition  and  in  rachitis;  but,  owing  to 
the  very  disagreeable  taste  of  pure  phosphorus,  we  usually  have  to  be 
content  with  the  use  of  phosphates,  hypophosphites  and  dilute  phos- 
phoric acid.  The  most  common  form  of  pure  phosphorus  for  admin- 
istration is  the  official  pill  containing  y^q-  of  a  grain  (0.0006  gm.).     It  is 

*  Therapeutics,  H.  C.  Wood,  eleventh  edition,  pp.  431-32. 

14 


210  GENERAL   REMEDIES 

particularly  indicated  in  certain  diseases  of  the  nervous  system  and  in 
conditions  of  deficient  bone  nutrition. 

(For  poisoning  by  phosphorus,  see  Table  of  Poisons  and  Antidotes.) 

Acidum  Phosphoricum  Dilutum.  Diluted  Phosphoric  Acid.  10  per 
cent.  This  acid  is  used  as  a  general  nerve  tonic  and  substitute  for 
phosphorus.    In  neurasthenia  it  is  a  useful  agent. 

Syrupus  Hypophosphitum.  Syrup  of  PIypophosphites.  (Incom- 
patible with  tincture  of  chloride  of  iron.) 

Syrupus  Hypophosphitum  Compositus.  Compound  Syrup  of  Hypo- 
phosphites. 

Syrupus  Ferri,  Quininae  et  Strychninse  Phosphatum.  Syrup  of  the 
Phosphates  of  Iron,  Quinine  and  Strychnine. 

The  hypophosphites  are  useful,  both  as  substitutes  for  phosphorus 
and  as  furnishing  combinations  of  the  drug  that  may  be  more  easily 
appropriated  by  the  system.  They  are  certainly  less  unpleasant  to  take. 
They  are  largely  used  in  rachitis,  in  wasting  diseases  such  as  tuberculosis, 
and  in  diseases  of  the  blood  and  of  the  nervous  system. 

Oleum  Morrhuae.  Cod-liver  Oil.  A  fixed  oil  expressed  from  the 
fresh  livers  of  Gadus  morrhua  and  other  species  of  Gadus. 

It  is  produced  mostly  upon  the  coasts  of  Norway,  Newfoundland  and 
Massachusetts. 

Its  value  is  that  of  a  fatty  food  which  also  contains  traces  of  iodine, 
chlorine,  bromine,  phosphorus  and  sulphur.  These  contribute  a  slightly 
alterative  property  to  the  oil.  It  is  used  in  wasting  diseases,  especially 
in  tuberculosis,  and  in  poorly  nourished  children.  The  so-called 
scrofulous  conditions  are  benefited  by  it.  The  taste  of  the  oil  is  dis- 
agreeable to  many,  so  it  is  used  largely  in  the  form  of  emulsion.  The 
pure  oil  is  sometimes  used  by  inunction  when  stomach  administration 
is  impracticable.  If  taken  about  two  hours  after  meals  (about  the  time 
the  contents  of  the  stomach  pass  on  into  the  small  intestine),  so  as  to 
shorten  the  time  of  its  stay  in  the  stomach,  much  of  the  unpleasantness 
in  the  way  of  eructations  will  be  avoided.  The  official  emulsions  are 
the  following: 

Emulsum  Olei  Morrhuae.    Emulsion  of  Cod-liver  Oil.     50  per  cent. 

Emulsum  Olei  Morrhuae  cum  Hypophosphitibus.  Emulsion  of  Cod- 
liver  Oil  with  Hypophosphites.  This  contains  50  per  cent,  oil, 
with  hypophosphites  of  calcium,  potassium  and  sodium. 


CHAPTER   XVI. 

ALTERATIVES. 

Alteratives  have  been  defined  as  agents  that  counteract  morbid 
states  of  tissues  by  altering  the  processes  of  nutrition  in  a  favorable 
manner.  They  seem  to  have  little  direct  influence  upon  irritability  or 
functional  activity  of  cells.  Alteratives  become  a  part  of  the  cell  contents 
for  the  time  that  they  remain  in  the  system,  and  some  of  the  metallic 
alteratives  become  so  fixed  in  certain  organs  that  they  may  be  detected 
for  weeks  in  the  tissues.  Their  action  is  slow  and  their  effects  permanent, 
as  might  be  expected  of  agents  that  enter  so  intimately  into  the  com- 
position of  the  cells.  The  typical  conditions  that  call  for  the  use  of 
alteratives  are  those  that  are  brought  about  by  the  damaging  influence 
of  external  causes,  usually  bacteria  or  toxic  chemical  bodies,  that  alter 
the  nutrition  of  the  cells.  Syphilis  stands  as  the  disease  that  probably 
most  purely  both  presents  the  indications  for  the  use  of,  and  responds 
most  readily  to  the  action  of,  alteratives. 

Altered  states  of  the  blood  and  of  various  organs  likewise  call  for 
their  use. 

The  precise  mode  of  action  of  alteratives  is  obscure,  their  effects 
appearing  without  any  evident  changes  of  organic  functions,  except  that 
of  gradual  improvement. 

Arseni  Trioxidum.  Arsenic.  Arsenous  Acid  [AS2O3].  The  value 
of  arsenic  internally  is  mostly  as  a  blood  alterative,  in  those  forms  of 
anemia  where  the  red  cells  are  abnormal.  It  is  also  useful  in  chlorosis 
and  in  certain  nervous  diseases,  particularly  in  chorea  (St.  Vitus'  dance), 
and  in  some  chronic  diseases  of  the  skin.  (For  reactions  and  doses  of 
the  following  preparations,  see  Index  of  Drugs.) 

Liquor  Acidi  Arsenosi.     Solution  of  Arsenous  Acid.     1  per  cent. 

Liquor  Potassii  Arsenitis.  Fowler's  Solution.  Strength  corresponds 
to  1  per  cent,  of  arsenic  trioxide. 

Liquor  Sodii  Arsenatis.     1  per  cent. 

Liquor  Arseni  et  Hydrargyri  lodidi  Donovan's  Solution.  1  per  cent, 
each  of  arsenous  iodide  and  mercuric  iodide. 

The  pure  arsenic  trioxide  and  Fowler's  solution  are  the  forms  most 
commonly  employed.     Beginning  with  small  or  moderate  doses,  they 

(211) 


212  GENERAL  REMEDIES 

may  be  increased  to  the  limit  of  toleration,  which  is  shown  by  irritability 
of  the  stomach  and  puffiness  about  the  eyelids. 

Donovan's  solution  is  a  more  powerful  general  alterative,  as  it  com- 
bines arsenic,  mercury  and  iodine. 

It  is  interesting  to  note  that  in  some  parts  of  the  world  persons  become 
habituated  to  taking  quite  large  doses  of  arsenic. 

Hydrargjnrum.  Mercury.  Quicksilver  [Hg].  (For  fuller  list  of 
preparations  and  doses,  see  Index  of  Drugs.)  Mercury  is  used  very 
largely  in  the  form  of  combinations,  but  there  are  several  preparations 
in  which  metallic  mercury  is  reduced  to  a  very  finely  divided  condition. 
Following  are  the  preparations  most  commonly  used: 

Hydrargynim  cum  Creta.  Mercury  with  Chalk.  Contains  38  per 
cent,  metallic  mercury. 

Massa  Hydrargyri.  Blue  Mass.  Blue  Pill.  Contains  33  per  cent, 
metallic  mercury. 

Unguentum  Hydrargyri.  Blue  Ointment.  Contains  50  per  cent, 
metallic  mercury. 

Oleatum  Hydrargsrri.  Oleate  of  Mercury.  Contains  25  per  cent, 
yellow  oxide  of  mercury. 

Hydrargyri  Chloridum  Mite.  Mild  Chloride  of  Mercury.  Calomel. 
Monochloride  of  Mercury  [HgCl]. 

Hydrargyri  Chloridum  Corrosivum.  Corrosive  Chloride  of  Mer- 
cury.    Corrosive  Sublimate.    Bichloride  of  Mercury  [HgClJ. 

Hydrargyri  lodidum  Flavum.     Yellow  Mercurous  Iodide. 

Hydrargyri  lodidum  Rubrum.     Red  Mercuric  Iodide. 

The  typical  use  of  mercury  as  an  alterative  is  in  the  treatment  of 
secondary  syphilis.  As  it  is  desirable  to  obtain  its  full  influence  as  soon 
as  possible,  the  ointment  or  the  oleate  may  be  rubbed  into  the  skin 
freely.  Aside  from  these  the  non-cathartic  preparations  may  be  em- 
ployed internally.  Blue  mass  and  calomel  are  seldom  given  in  syphilis, 
but  are  valuable  cathartic  agents. 

The  constitutional  symptoms  produced  by  mercury,  with  the  treat- 
ment of  the  same,  are  discussed  in  the  article  on  Antiseptics.  (See  also 
the  article  later  on  Syphilis  and  its  Treatment.) 

lodum.  Iodine  [I].  This  substance  is  not  commonly  administered  in 
its  free  state  internally,  because  of  its  irritating  character.  It  is,  however, 
a  valuable  alterative,  and  may  be  taken  In  large  quantity  in  non-irritant 
combinations.  The  iodides,  which  contain  a  large  proportion  of  iodine, 
constitute  a  distinct  group  of  general  alterative  agents,  the  most  typical 
of  which  is  potassium  iodide. 


ALTERATIVES  213 

Potassii  lodidum  [KI].  Estimated  by  the  atomic  weights  of  its 
components,  this  salt  contains  76  per  cent,  of  iodine.  Being  much  less 
irritating  than  iodine,  it  furnishes  the  means  of  getting  a  large  amount 
of  the  latter  into  the  system  without  much  disturbance.  This  salt  is 
used  in  the  treatment  of  acute  asthma,  in  chronic  rheumatism  and  other 
conditions  of  tissue  alteration,  but  its  most  extensive  use  is  in  tertiary 
syphilis,  where  its  influence  is  so  certain  and  striking  as  to  entitle  it  to 
be  regarded  as  an  absolute  specific  for  that  disease  in  that  stage.  (See 
article  below  on  S}^hilis  and  its  Treatment.) 

Sodii  lodidum  [Nal].  Sodium  iodide  has  about  84  per  cent,  of  iodine 
in  its  composition.    Its  uses  are  the  same  as  those  of  the  potassium  salt. 

Other  iodides  are  useful  according  to  the  particular  combinations 
employed.  The  following  are  some  of  the  most  important  preparations 
in  frequent  use: 

Syrupus  Ferri  lodidi.  Syrup  of  Iodide  of  Iron.  This  is  a  very 
valuable  preparation  for  use  in  the  so-called  "scrofulous"  conditions. 
It  may  be  taken  for  an  indefinite  period  by  children  who  show  the 
characteristic  enlargement  of  lymph  nodes. 

Arseni  lodidum  [Aslg].  Arsenous  iodide  is  used  chiefly  in  Donovan's 
solution,  the  liquor  arseni  et  hydrargyri  iodidi. 

Syphilis  and  its  Treatment. 

Syphilis  is  a  disease  that  is  contagious  and  infectious  in  nature, 
one  that  may  be  met  with  in  any  walk  of  life,  whether  acquired 
innocently  or  through  vicious  conduct.  It  may  be  inherited  in  cer- 
tain of  its  forms.  It  is  a  disease,  moreover,  of  which  its  possessor  may 
be  ignorant,  both  as  to  its  character  and  the  source  of  infection. 
Wliile  the  latter  is  comparatively  seldom  true,  the  fact  is  sufficiently 
established  by  occurrence  of  the  lesion  of  original  infection,  the  chancre, 
upon  various  parts  of  the  surface  of  the  body,  where  infection  must 
have  been  purely  accidental.  The  importance  of  these  facts  to  the 
dentist  is  emphasized  by  the  further  fact,  that  the  highly  infectious 
secondary  lesions  are  prominent  in  the  mouth  and  throat,  constituting 
here  a  danger  to  the  dental  operator  directly,  and  to  others  indirectly. 
Syphilitic  lesions  are  commonly  painless,  which  adds  to  the  danger  of 
non-recognition  of  the  superficial  mouth  lesions.  The  occasional  occur- 
rence of  a  chancre  upon  the  hand  of  a  dentist,  justifies  the  advice  that 
a  constant  outlook  for  the  presence  of  the  disease,  in  mouths  coming 
under  examination,  should  be  exercised.  This  implies  a  certain  degree 
of  familiarity  with  the  symptoms  of  the  disease.    Every  opportunity  to 


214  GEXERAL  REMEDIES 

acquire  this  knowledge  should  be  improved  as  a  matter  even  of  personal 
safety,  but  still  more  of  duty  to  others. 

The  dental  specialist  certainly  owes  it  to  his  patients  and  to  himself, 
to  supplement  his  dental  college  course  by  a  post-graduate  study  of 
SA'philis  in  its  chief  clinical  features. 

A  word  of  caution  is  here  in  place.  It  may  fall  to  the  practitioner  to 
discover  a  case  of  s^-philis,  by  mouth  s^miptoms,  where  it  had  not  been 
suspected;  but  he  must  be  exceedingly  cautious  about  discussing  this 
finding  ^rith.  his  patient.  He  is  dealing  with  a  matter  for  which  he  has 
not  been  consulted,  and  in  any  suspicious  acts  or  words  of  his,  lie  the 
possibilities  of  much  unpleasantness.  If  the  patient  be  an  innocent  wife 
a  statement  of  his  discovery  might  produce  domestic  discord.  AMiile 
she  would  have  a  most  serious  grievance,  entitling  her  to  our  pity,  a 
revelation  could  only  add  to  her  unhappiness.  A  suggestion  to  her  to 
see  her  family  physician  for  certain  general  conditions  that  you  find 
evidence  of,  would  be  the  proper  course;  and  even  this  ad^ice  must  be 
given  tactfidly,  without  arousing  suspicion  as  to  the  probabilities  in  the 
case,  for,  after  all,  a  mistaken  diagnosis  is  possible.  Any  other  course 
would  also  endanger  professional  relations  with  the  family  physician. 
The  greatest  point  of  practical  importance  is,  to  be  so  careful  in  the 
manipulation  of  instruments  as  to  avoid  all  danger  of  self-infection;  for 
the  saliva  of  a  patient  with  secondary  mouth  symptoms  may  infect  any 
abrasion  of  the  skin  that  it  comes  in  contact  with.  It  is  further  under- 
stood, as  a  matter  of  course,  that  all  instruments  and  appliances  used 
will  be  thorotighly  sterilized  immediately  after  the  operation. 

As  a  basis  for  study,  a  scheme  is  herewith  given,  which  includes  stages 
of  the  disease  with  their  characteristic  s^inptoms,  and  the  application  of 
remedies  appropriate  to  each.  "  This  is  arranged  in  accordance  with  the 
usual  custom,  sufficiently  founded  upon  long  experience,  which  is  that 
the  treatment  by  alteratives  is  commonly  postponed  until  the  diagnosis 
has  been  established  by  positive  secondary  s^Tnptoms;  otherwise  the 
treatment  might  prevent  a  diagnosis,  and  the  patient  would  not  know 
whether  he  were  s\'philitic  or  not.  Positive  knowledge  upon  this  point 
is  so  important,  in  xie^x  of  the  cpestions  of  marriage,  of  prolonged  treat- 
ment, and  of  personal  care  as  to  spreading  of  infection,  that  the  matter 
of  a  few  weeks'  treatment  may  be  properly  disregarded,  particularly  so 
as  it  is  believed  that  nothing  is  lost,  in  the  efficacy  of  treatment,  by  the 
delay. 

The  chief  remedy  during  the  secondary  stage  is  mercury.  This  drtig 
is  administered  by  inimction  or  internally,  in  full  dosage,  until  the  first 


ALTERATIVES 


215 


signs  of  mercurialism  appear  in  a  slight  soreness  of  the  teeth  when  the 
jaws  are  forcibly  closed.  Then  the  dose  is  diminished,  but  continued 
in  such  quantity  as  is  necessary  to  keep  the  system  just  at  the  point  of 
saturation.  This  treatment  is  continued  for  several  months,  when 
potassium  iodide  is  added.  The  combination  of  the  two,  known  as 
"mixed  treatment,"  is  continued,  with  a  gradual  diminution  of  mercury 
and  increase  of  potassium  iodide,  until  finally  the  treatment  ends  with  a 
course  of  the  iodide  alone.*  The  practice  of  physicians  differs  in  detail 
as  to  method  and  time,  but  the  general  plan  is  essentially  that  presented 
here. 

Syphilis,  its  Stages,  Symptoms  and  Treatment. 


Primary   symptoms 
appear  about  three 
weeks  after  infec- 
tions.   The  lesion  is   \ 
very  infectious. 


SYMPTOMS. 

f  a.  The  chancre,  located  usually  upon  the  geni-  '] 
I  tals,  but  may  occur  upon  any  mucous  or   j 

J  cutaneous  surface.  ' 

b.    Enlargement  of  lymph  nodes  in  all    parts   { 
of  the   body,  but   not    distinctive  of  this    | 
l_  disease.  J 


Secondary   symptoms    f 
occur  about  six  or 
eight  weeks    after 
infection.     The  le- 
sions in  the  mouth  1 
(mucous   patches) 
are  exceedingly   in- 
fectious. 


A  superficial  rash,  slight  or  abundant,  dis-  ") 
tributed  upon  all  regions  of  the  body. 

b.  Sore  throat.  | 

c.  Mucous  patches  anywhere  upon  mucous  mem-   | 

brane  of  mouth   or  throat,  usually  upon    f 
inner  surface  of  cheeks  or  under  tongue. 

d.  Loss  of  hair,  slight  or  marked. 


Tertiary  m/mptoms 
may  be  prevented 
by  treatment.     In 
cases    not    treated 
the  tertiary  symp- 
toms occur  in  from 
one-half  to  two 
years  after  infec- 
tion, but  they  may 
be  delayed.     The 
lesions  are   only 
slightly,  or  not  at 
all,  infectious. 


f  a.  Deeper  lesions  of  the  skin,  either  single  or 
I  multiple,  but  not  of  general  distribution. 

I   b.   Periosteal  pains,  chiefly  in  head  and  long 
bones,  occurring  raiostly  at  night. 
.   Gumma,  occurring  mostly  upon  skin,  in  the 
nervous  system,  or  smaller  bloodvessels,  but 
occasionally  in  any  part  of  the  system. 
\.  Deep  ulcers  of  the  skin  sometimes  resulting 
from    the    breaking    down    of   gummata. 
Usually  single,  or,  if  double,  located  upon 
symmetrical  portions  of  body. 
.   Degenerations  of  circulatory  or  nervous  sys- 
tems.    The  arteries,  brain  and  spinal  cord 
are  usual  sites  of  degeneration. 


MEDICINAL 
TREATMENT. 


Unimportant. 


Mercury. 


I  Potassium 
iodide. 


The  question  whether  syphilis  may  be  cured  has  been  regarded  as  a 
debatable  one,  but  it  is  one  which  now,  in  the  minds  of  experienced 
syphilographers,  admits  of  an  affirmative  answer.  The  fact  remains, 
however,  that  comparatively  few  cases  are  permanently  cured.  When 
we  appreciate  that  a  cure  means  the  taking  of  medicines  almost  con- 


*  The  continued  use  of  any  iodide  commonly  produces  a  rash,  consisting  of  pimples 
upon  the  face  and  elsewhere,  which  is  believed  to  be  nature's  efforts  to  eliminate 
iodine.     This  is  the  chief  symptom  of  iodism,  or  saturation  with  the  drug. 


216  GENERAL  REMEDIES 

tinuously  for  two  or  three  years,  and  that  syphihs  is  a  disease  whose 
syraptoms  yield  very  promptly  to  treatment,  it  cannot  be  expected  that 
more  than  a  small  percentage  of  patients  will  continue  treatment  for 
the  necessary  length  of  time  after  they  feel  perfectly  well. 

With  the  discovery  of  the  spirocheta  pallida  a  new  chapter  in  the  study 
of  syphilis  and  its  treatment  has  been  opened.  The  relation  of  this  bac- 
terium to  the  disease  is  being  studied  by  various  observers  and  it  is  coming 
to  be  quite  generally  regarded  as  the  specific  cause  of  syphilis.  With 
the  cause  thus  recognized,  improvement  in  management  of  the  disease 
is  quite  sure  to  follow,  for  the  purely  empirical  treatment  of  the  past 
will  in  time  be  placed  upon  a  scientific  basis,  and  it  is  to  be  hoped  that 
the  period  of  treatment  necessary  to  a  cure  may  be  shortened. 

The  following  additional  drugs  are  simply  mentioned  as  represen- 
tative of  the  class  of  vegetable  alteratives: 

Colchicum.     (For  preparations,  doses  and  uses,  see  Index  of  Drugs.) 
Guaiacum.     (For  preparations,  doses  and  uses,  see  Index  of  Drugs.) 
Sarsaparilla.     (For  preparations,  doses  and  uses,  see  Index  of  Drugs.) 
Sarsaparilla  must  be  regarded  as  the  least  valuable  of  this  group. 
In  fact,  its  value  is  so  slight  that  it  is  seldom  used  alone.     The  pro- 
prietary   "sarsaparilla   tonics"    all    contain    stronger    agents,    usually 
cathartic  in  action. 


PLATE    XIV. 


ACONITE. 

The  tuber  of  A.  Xapellus. 

The  alkaloid  Acouitiue  repre- 
sents the  drug  fully,  but  is 
the  most  poisonous  substance 
of  its  class.  Therefore  it  is 
seldom  used  internally. 

[For  preparations  and  doses, 
see  Index  of  Drugs.] 


Classified  as 


Sensory 


..■11  nerve  endina,'- 

Arterial  depressamt  ,  ,     ^ 

^      _       ^    ^  depressed 

Cardiac  depressant. 

Kerve  depressant. 

Antipyretic. 


Physiologic  action : 

S^ervous  System. 

Brain.     Xo  influence  upon  cerebrum. 
Medulla.      Stimulates  vagus   center. 

depresses  respiratory  center. 
Spinal  cord.     Influence  uncertain. 
Sensory  nerve  endings  are  depressed  after  a  period  of 

slight  stimulation. 

Muscular  System.     Causes  genei-al  muscular  weakness. 

Circulation.  Lessens  force,  rapidity  and  pressure  of  the  arterial 
current. 

Heart.  A  dii-ect  influence  upon  the  heart  is  uncertain,  but 
by  stimulation  of  inhibition  the  heart  is  slowed  and  its  force 
weakened  — the  result  being  cardiac  depression,  f  Accord- 
ing to  some  authorities,  the  drug  depresses  the  heart  muscle 
and  its  motor  ganglia.) 

Capillary  area.  The  vasomotor  influence  of  the  drug  is 
uncertain. 

Temperature  is  reduced. 


Valgus  Center 

Vaso  Motor 

Center 
Cervical 
Syjiijiathetic 


The  red  color  iudicates  the  stimulant  action 
of  Aconite  upon  the  vagus  center,  which 
causes  slowing  of  the  heart's  action.  The 
blue  color  indicates  the  depressant  effect 
of  the  drug. 


CHAPTEK  XYII. 

SEDATIVES. , 

A  SEDATIVE  is  defined  to  be  an  agent  that  diminishes  the  activity  of 
an  organic  function  or  process;  the  term  depressant  being  equally 
applicable.  All  sedatives  may  be  poisonous  when  given  in  large  dose; 
and  the  toxic  symptoms  usually  include  narcosis.  The  division  of  the 
large  list  of  sedative  agents  into  groups  designated  by  the  terms  arterial, 
nervous,  etc.,  is  a  convenience,  and  helps  to  fix  their  characteristic 
action,  but  no  distinct  lines  can  be  drawn  between  the  groups.  The 
terms  point  rather  to  the  most  prominent  features  of  their  action.  (See 
classification,  page  39.) 

Just  as  with  stimulants,  so  with  sedatives,  the  term  applies  to  effect, 
but  not  always  to  action.  Stimulation  of  inhibition  may  produce  a 
slowing  or  restraining  effect,  which  we  may  call  sedation  induced 
indirectly  by  stimulation.  Instances  of  this  kind  are  well  illustrated  in 
the  action  of  aconite,  as  Plate  XIV.  shows.  Most  sedatives,  however, 
produce  their  effects  by  a  direct  depressant  action  upon  either  nerve  or 
muscle  tissue. 

As  a  rule,  children  bear  the  moderate  action  of  sedatives  very  well. 
The  nervous  system  during  childhood  is  so  sensitive  and  responsive, 
that  disturbed  function  in  most  cases  calls  for  depressant  rather  than 
stimulant  treatment. 

Cold  must  be  given  a  prominent  place  among  the  arterial  sedatives. 
Just  as  the  application  of  heat  acts  as  a  general  stimulant,  so  the  appli- 
cation of  cold  produces  the  opposite  effect.  Hyperemias  and  acute 
inflammations,  whether  in  and  about  a  tooth  or  elsewhere,  injuries 
to  tissues  leading  to  extravasation  of  blood,  cardiac  and  cerebral  excite- 
ment, may  all  be  greatly  relieved  by  the  continuous  application  of  cold. 
In  this  class  of  conditions,  however,  the  rule  should  be  recognized  of 
employing  either  cold  or  heat  according  to  which  affords  the  most  relief. 
Methods  of  applying  cold  are:  the  full  or  partial  cold  bath,  the  Leiter 
coil  through  which  ice-water  is  allowed  to  run,  the  ice-bag,  and  the 
application  of  liquids  that  evaporate  rapidly.     The  employment  of 

freezing  methods  belongs  to  another  chapter. 

(217) 


218  GENERAL  REMEDIES 

Depletion  of  the  Circulation,  whether  by  bloodletting,  sweating  or 
active  catharsis,  is  another  means  of  reducing  circulatory  activity,  in 
addition  to  which  effect  these  measures  also  reduce  toxicity,  when  that 
becomes  necessary. 

Of  the  medicinal  agents  the  most  typical  ones  of  the  several  groups 
are  here  presented. 

Aconitum.     (Plate  XIV.) 

This  drug  i^  used  in  fevers  and  inflammations,  to  reduce  arterial  press- 
ure. The  tincture  is  used  internally,  either  5  to  15  minims  (0.30-1  c.c.) 
several  times  daily,  or  in  two-drop  doses  hourly  until  the  effect  is  secured! 
It  must  be  noted  that  the  new  official  tincture  of  aconite  (U.  S.  P.,  1900)  is 
less  than  one-third  as  strong  as  that  heretofore,  the  proportion  of  drug 
used  having  been  reduced  from  35  per  cent,  to  10  per  cent. 

With  an  equal  part  of  tincture  of  iodine,  the  tincture  is  used  as  an 
application  in  pericementitis  and  pulpitis.  In  neuralgias  the  alkaloid 
aconitine  is  employed  locally  in  form  of  the  oleate. 

Veratrum  Viride  and  Veratrine  have  an  action  which  resembles  closely 
that  of  aconite. 

(For  preparations  and  doses,  see  Index  of  Drugs). 

The  uses  of  these  are  very  similar  to  those  of  aconite.  In  addition 
veratrum  viride  is  used  to  reduce  arterial  pressure  in  puerperal  con- 
vulsions. 

Acidum  Hydrocyanicum  Dilutum.     (See  liidex  of  Drugs.) 

The  preparations  of  wild  cherry  (Prunus  virginiana)  owe  their 
sedative  value  to  the  presence  of  a  small  quantity  of  hydrocyanic  acid. 
These  are  useful  as  excipients  in  cough  mixtures;  but  when  a  decided 
effect  from  definite  dosage  is  desired,  the  dilute  hydrocyanic  acid  (2  per 
cent.)  is  used  in  doses  of  1  to  2  minims  (0.06-0.12  gm.).  The  strong 
hydrocyanic  or  prussic  acid  is  never  used,  as  it  is  too  poisonous  even 
to  manufacture. 

Bromides.     (Plate  XV.) 

This  group  of  salts  are  freely  soluble  in  water,  salty  to  the  taste 
and  slightly  irritating  to  the  mucous  membrane  if  applied  pure.  Potas- 
sium bromide  is  most  commonly  used,  although  the  sodium  salt  is  pre- 
ferred by  some  because  slightly,  less  irritating. 

The  bromides  are  used  in  any  conditions  where  there  is  cerebral  or 
nervous  excitement;  in  headaches,  injuries  to  the  brain,  meningitis, 
hysteria,  in  epilepsy  and  other  convulsive  disorders;  to  control  vomiting 
of  reflex  or  cerebral  origin.    They  are  of  special  value  in  the  nervous 


PLATE    XV. 


POTASSIUM 

BROMIDE. 

[KBr] 

[This  drug  is  regarded  as  tlie 
typical  and  most  important 
agent  of  the  group  of  bro- 
mides.] 

Classified  as  : 

Cerebral  depressant. 
Nerve  depressant. 
Antispasmodic. 
Anaphrodisiac. 


Sensory 
nerve  endings 
depressed 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


Solar  Plexus 


Physiologic  action : 

The  depressant  effect  is  due  in  part  to  the  potassium 
base,  which  is  especially  depressant  to  the  heart. 

Nervous  System. 

Brain.     Depresses  the  cerebral  cortex,  and   espe- 
cially the  motor  areas. 

Medulla.  Depresses  the  respiratory  center  slightly,  slowing 
the  respiration. 

Spinal  cord.  Lessens  reflex  irritability,  probably  mainly 
through  a  depression  of  the  sensory  portion  of  the  cord  and 
the  peripheral  terminals  of  the  sensory  nerves. 

Sensory  nerve  endings  are  depressed,  causing  a  slight 
degree  of  anesthesia  in  some  regions. 

Sexual  function  is  depressed. 
Circulation.     Arterial  pressure  is -lowered  somewhat. 

Heart.     Depresses  the  heart  slightly. 

Capillary  area.     Full  doses  cause  vasomotor  relaxation. 
Elimination.     The  drug  is  absorbed  rapidly  from  the  stomach,  but 
is  eliminated  slowly.     It  may  be  found  in  the  several  excre- 
tions, but  chiefly  in  the  urine. 

Doses  and  compai-ative  action  of  the  bromides : 

Potassii  Bromidum     ....  gr.  5-60  (Gm.  .30-4). 

Sodii  Bromidum gr.  5-60  (Gm.  .30-4). 

Less  irritating  and  rather  less  depressing. 

Ammonii  Bromidum   ....  gr.  5-30  (Gm.  .30-2). 
Least  depressing  owing  to  the  ammonium  base. 

The  blue  color  indicates  the  sedative 
effects  of  the  Bromides,  their  action 
upon  the  nervous  system  being 
much  more  important  than  that 
upon  the  circulation. 


SEDATIVES  219 

and  febrile  disturbances  that  occur  so  readily  during  infancy.  They  may 
be  given  freely,  but  always  well  diluted  so  as  not  to  irritate  the  stomach.* 
The  importance  of  sedatives  to  the  management  of  first  dentition 
leads  to  a  brief  consideration  of  that  subject  following  the  antipyretic 
group. 

ANTIPYRETIC  GROUP. 

These  newer  synthetic  agents  are  coal-tar  derivatives,  all  of  which 
occur  in  the  form  of  white  crystalline  powders. 

As  antipyretic  sedatives  they  have  power  to  lessen  temperature  in 
fever,  and  in  addition  they  have  anodyne  properties.  In  fact,  since  they 
have  come  to  be  recognized  as  sedatives,  being  on  that  account  inad- 
missible in  the  severe  fevers,  they  have  found  their  most  extensive  use 
in  the  treatment  of  headaches,  neuralgias  and  myalgias.  They  differ 
in  their  activity  and  safety. 

(For  solubilities  and  doses,  see  Index  of  Drugs.) 

Antip3n:ina  [CjjHj2N20].  This  is  the  mildest  in  action  and  is  also 
most  soluble.  It  is  of  some  value  as  an  antispasmodic  in  the  treatment 
of  infantile  convulsions  and  whooping-cough. 

Incompatibility.  Antipyrine  is  incompatible  with  spirit  of  nitrous 
ether  and  with  solutions  of  carbolic  acid. 

Acetphenetidinum.  Phenacetine  [C^oHj3N02].  This  is  more 
powerful  than  antipyrine,  but  comparatively  safe.  It  is  practically 
insoluble  in  water. 

Acetanilidum  [QHgNO].  This  is  the  most  powerful  of  the  group 
and  least  safe.  It  is  sparingly  soluble  in  water.  It  has  the  power  of 
producing  alterations  in  the  blood  that  may  cause  a  decided  appearance 
of  cyanosis,  when  full  doses  are  taken  repeatedly,  or  too  large  quantity 
in  a  single  dose.  It  must  be  used  cautiously,  if  at  all,  and  never  con- 
tinuously for  any  length  of  time.    The  compound  powderf  is  a  useful 

*  While  the  bromides  in  their  ordinary  uses  are  without  danger,  it  should  not  be 
concluded  that  they  are  incapable  of  doing  harm.  Their  prolonged  use  is  not  desir- 
able, because  they  certainly  do  depress  cerebral  and  nerve  functions.  The  only 
unpleasant  symptom  commonly  attending  their  prolonged  use  is  the  occurrence  of 
pimples  upon  the  face  and  elsewhere,  which  is  believed  to  be  nature's  effort  to  elim- 
inate bromine. 

t  Pulvis  Acetanilidi  Compositus.     (U.  S.  P.) 

Gm.  or  c.c. 
R . — Acetanilidi,  7 

Caffeinse,  1 

Sodii  bicarbonatis,  21         — M. 

Of  this  the  dose  is  IJ  to  8  grains  (0.10-0.50  gm.). 


220  GENERAL  REMEDIES 

internal  analgesic.  The  caffeine  in  this  may  aid  the  action  of  the 
acetanilid,  but  it  antagonizes  its  depressant  action  upon  the  nervous 
system  and  heart. 

Locally,  acetanilid  is  used  as  an  antiseptic  powder. 

First  Dentition  Complications  and  Their  Treatment. 

It  has  been  remarked  that  children  bear  sedatives  relatively  better 
than  they  do  stimulants.  The  basis  of  this  fact  is  found  in  the  more 
sensitive  nervous  system  of  the  child.  If  we  compare  the  size  of  the 
brain  at  birth  with  the  total  weight  of  the  body,  we  find  that  its  relative 
size  greatly  exceeds  that  of  the  adult  brain.  At  the  same  time  its  function 
is  more  complex  in  that  it  is  concerned  with  the  process  of  development, 
which  becomes  inactive  later  on. 

In  consequence  of  this  greater  sensitiveness  of  the  child's  nervous 
system,  impressions  are  magnified;  not  only  do  slight  mental  impressions 
beget  fear  or  emotional  outbreak,  but  slight  nerve  irritation  which  in  an 
adult  would  be  unnoticed,  or,  at  most,  would  cause  slight  discomfort, 
in  a  child  may  produce  fever  and  convulsions.  Accordingly,  a  stimulant 
that  acts  through  exciting  or  irritating  a  function  or  tissue  will  disturb 
rather  than  soothe,  while  a  sedative  will  lessen  the  sensitiveness  of  nerve 
tissue  and  prevent  the  disturbances  of  function.  Although  occasionally 
so  much  depression  may  occur  as  to  call  for  stimulants,  as  a  rule  they 
may  be  dispensed  with  in  childhood,  while  sedatives  hold  a  place  of 
supreme  importance,  both  as  agents  to  prevent  and  to  control  the 
serious  nervous  disturbances  that  occur  so  easily  during  that  period 
of  hfe. 

But  the  common  causes  of  infantile  disturbances  are  not  external, 
but  rather  the  irritations  that  proceed  from  functions  abnormally 
performed  within  the  body.  These  irritations  may  be  of  great  variety; 
but  as  we  see  the  extreme  sensitiveness  gradually  disappear  with  the 
development  of  the  child,  we  recognize  that  the  maximum  of  suscepti- 
bility to  irritation  exists  early,  or  during  the  period  corresponding  to 
first  dentition.  Thus  we  may  fix  the  time  of  greatest  disturbance,  but 
must  study  further  the  causes.  We  must  be  reminded  that  during  this 
period  the  whole  digestive  tract  is  being  prepared  for  a  more  complex 
function,  that  of  digesting  food  of  firmer  quality  and  greater  variety. 
From  the  teeth  downward  the  provisions  for  solution  and  absorption  of 
food  are  being  developed  and  adapted,  and  throughout  there  is  con- 
nection with  the  same  sensitive,  directing  and  controlling  central  nervous 
system.     This  is  often  shown  very  emphatically  by  the  occurrence  of 


SEDATIVES  221 

vomiting  or  convulsions  after  the  self-indulgent  parent  has  enjoyed 
seeing  the  infant  sit  at  the  table  and  partake  of  the  common  family- 
dishes,  for  which  its  digestive  apparatus  has  not  yet  been  prepared. 

Of  all  of  the  developmental  changes,  the  process  of  eruption  of  the 
teeth  is  the  most  visible;  and  it  has,  therefore,  been  blamed  too  indis- 
criminately for  the  disturbances  that  often  coincide  with  it.  It  is  so  easy 
to  satisfy  anxious  inquiry  by  the  statement  that  the  convulsion  in  a  given 
case  is  due  to  teething,  or,  if  that  is  improbable,  to  suggest  that  the  child 
may  have  worms. 

Without  denying  for  a  moment  that  abnormal  dentition  may  be  the 
cause  of  most  serious  disturbances,  we  must  take  a  comprehensive 
view  of  the  developmental  diseases  of  infancy  and  not  be  too  much 
influenced  by  what  we  may  see  at  either  end  of  the  digestive  tract. 
Teething  and  worms  each  have  a  pathologic  importance,  but  we  must 
not  allow  them  to  usurp  attention  that  belongs  to  factors  less  apparent, 
but  undoubtedly  more  important  in  many  cases.  We  must  hold  improper 
diet  to  be  an  influence  of  first  importance,  and  this  refers  not  only  to 
character  of  food,  but  to  quantity  and  to  intervals  of  feeding  as  well. 
Fermentation  and  putrefaction  of  food  materials,  and  even  infection  in 
the  intestinal  tract,  are  prominent  factors  of  disease  at  any  age;  but  in 
the  sensitive  child,  with  full  digestive  capacity  undeveloped,  such  factors 
are  of  superlative  importance. 

There  is,  however,  occasionally  seen  a  case  of  the  most  serious  general 
disturbance,  where  dentition  and  the  digestive  function  appear  to  be 
normal,  that  must  be  attributed  to  a  special  susceptibility  or  an  abnor- 
mality in  the  nervous  system  itself.  Again,  we  are  convinced  of  the 
prominence  of  the  central  nervous  system  as  a  primary  factor,  when  we 
see  a  child  of  unstable  nervous  constitution  have  a  convulsion  from  a 
cause  that  a  normal  child  will  successfully  resist. 

These  considerations  bring  into  prominence  the  part  of  treatment  that 
refers  to  the  nervous  system.  It  involves  temporary  prophylaxis  as 
well  as  relief,  and  includes  daily  supervision  of  the  child's  diet  and 
habits,  with  the  judicious  use  of  sedatives  in  order  to  lessen  the  irrita- 
bility of  nerve  centres,  so  that  they  may  respond  less  readily  to  irritating 
impressions. 

More  important  still  is  the  prophylaxis  that  fortifies  the  nerve  centres 
by  increasing  their  stability  or  tone.  Hygienic  measures,  including  an 
abundance  of  fresh  air,  daily  bathing  with  tepid  or  cold  water,  and 
proper  feeding,  meet  this  requirement. 

Probably  the  majority  of  children  suffer  with  irritability  and  feverishr 


222  GENERAL   REMEDIES 

ness  at  some  time  during  first  dentition.  As  a  rule  the  daily  discomfort 
becomes  more  marked  as  the  day  advances,  until  midnight  or  later, 
when  sleep  may  occur  with  frequent  interruptions.  Convulsion  or 
spasm  often  occurs  in  the  severer  cases.  The  treatment  of  the  condition 
will  include  the  hygienic  measures  previously  mentioned.  The  child 
should  be  taken  out  into  the  open  air  as  much  as  is  possible  during  the 
day  as  a  matter  of  routine  prophylaxis.  Fever  and  fretfulness  may  be 
lessened  by  cold  sponging  or  the  cool  bath.  Medicines  may  not  be 
needed  in  the  early  part  of  the  day,  but  later,  as  the  irritability  increases, 
the  bromides  may  be  given  freely  and  continued  until  the  child  rests.  If 
the  gums  show  great  hyperemia  over  advancing  teeth,  scarification  by 
means  of  a  clean  finger-nail  or  the  point  of  a  well-guarded  lancet  may  afford 
much  relief,  but  indiscriminate  lancing  of  the  gum  is  not  to  be  advised. 

To  refer  again  to  the  medicines  that  are  useful,  both  arterial  and  nerve 
sedatives  have  their  place,  according  to  the  predominance  of  vascular 
or  nervous  disturbance.  The  typical  arterial  sedative  drug  is  aconite. 
This  may  be  given  in  form  of  the  tincture,  in  a  dose  of  |  to  1  a  drop 
every  hour  until  the  circulatory  excitement  has  lessened.  Spirit  of 
nitrous  ether  may  be  combined  with  it  for  the  purpose  of  inducing 
sweating,  the  occurrence  of  which  will  reduce  the  fever. 

A  suggestive  prescription  for  a  child  one  to  two  years  old  is  as  follows : 


Gm.  or  c.c. 

R . — Tincturse  aconiti,  1 

Spiritus  {Etheris  nitrosi,  30 

Glycerini,  15 

cinnamomi,         q.  s.  ad     60 


{xri  XV) 

(fij) 
(fSiv) 
(f5ij)-M. 
Sig. — One-half  teaspoonful  in  water  every  hour  until  better. 

The  indications  for  this  combination  would  be  a  full,  rapid  pulse  with 
fever,  and  the  medicine  should  be  lessened  or  discontinued  when  these 
symptoms  abate.  Aconite  must  be  used  with  due  care,  for  it  is  a 
poisonous  drug  in  excessive  dose;  so  the  precise  indications  for  its  use 
and  the  favorable  result  of  its  action  should  determine  the  extent  of  its 
employment  in  any  case. 

In  most  cases,  the  danger  of  convulsions,  and  the  irritability  of  the 
nervous  system,  can  be  removed  by  the  bromides,  whose  action  is 
perfectly  safe.  Their  use  is  addressed  to  the  nervous  element,  which 
is  usually  very  prominent,  while  the  circulatory  disturbance  is  secondary 
and  incidental.  Therefore,  the  use  of  a  bromide  will,  on  the  whole, 
be  found  most  satisfactory,  because  it  meets  the  primary  indication  of 
lessening  the  sensitiveness  of  the  brain  centres  and,  at  the  same  time,  can 


SEDATIVES  223 

be  used  continuously  in  full  doses  without  danger.  Potassium  bromide 
is  the  typical  agent  of  the  group,  but  it  must  always  be  given  well  diluted, 
so  as  to  avoid  irritating  the  stomach.  The  writer  has  never  found  the 
drug  to  cause  vomiting  when  given  freely  diluted.  It  may  be  given 
in  a  dose  of  5  to  10  grains  (0.30-0.60  gm.)  to  a  child  one  year  old  in  the 
emergency  of  a  convulsion,  but  the  dose  for  continuous  administration  is  1 
to  3  grains  (0.06-0.20  gm.).   The  following  formula  is  simple  and  useful: 

B.- 


-Potassii  bromidi, 

Gm.  or  c.c 

2 

(gr.  xxx) 

Syrupi, 

15 

(fSiv) 

Aquge  cinnamomi, 

q.  s.  ad     60 

(fgii)-M. 

Sig. — A  teaspoonful  every  hour  while  restless. 

The  above  formula  may  answer  every  purpose  of  necessary  medication 
in  the  simple  irritability  of  the  period  of  first  dentition.  Following  the 
directions  previously  given  in  respect  to  hygienic  treatment,  the  bromide 
need  not  be  given  until  the  beginning  of  the  daily  period  of  increased 
irritability,  which  occurs  toward  evening.  Then  it  may  be  given  hourly 
until  the  child  is  able  to  rest.  It  is  then  advisable  to  stop  the  medicine 
until  the  next  afternoon,  or,  at  least,  to  reduce  it  to  longer  intervals  of 
administration  during  the  morning. 

A  free  purge,  by  the  use  of  castor  oil,  is  usually  proper  also,  the  dose 
being  1  to  2  teaspoonfuls  (4-8  c.c.)  or  more,  according  to  age. 

Convulsions.  "V^Tien  spasms  occur,  the  twitching  or  stiffness  of  the 
muscles  is  attended  by  unconsciousness.  This  shows  that  the  brain  is 
concerned  in  the  effects  of  the  irritation,  wherever  the  latter  originates. 
The  condition  must  be  treated  as  an  emergency,  the  aim  being  to  restore 
consciousness  and  relieve  the  convulsion.  The  head  is  usually  hot, 
while  the  extremities  may  be  cold.  The  treatment  will  embrace  several 
measures : 

1.  To  lessen  the  hyperemia  and  sensitiveness  of  the  brain. 

2.  To  remove  the  source  of  irritation,  or  lessen  its  severity. 

3.  To  stop  the  convulsion  directly,  if  that  result  does  not  follow  the 
treatment  under  1  and  2. 

Under  the  first  heading  we  employ  means  of  bringing  blood  to  the 
surface  of  the  body,  such  as  the  hot  (very  warm)  bath  to  the  whole  body 
except  the  head.  If  the  latter  is  hot,  cold  applications  should  be  made 
to  it,  as  this  will  aid  in  securing  the  same  object  by  driving  the  blood 
from  the  brain.  Mustard  flour  (1  to  4  teaspoonfuls,  mixed  first  with  a 
little  cold  or  tepid  water)  may  be  added  to  the  hot  bath  for  a  pronounced 
rubefacient  effect. 


224  GENERAL   FEME  DIES 

^Meanwhile,  treatment  coming  under  the  second  heading  should  be 
employed.  ^Miile  the  conAtilsiun  is  present  it  may  not  be  possible  to  at 
once  remove  the  irritation,  which  may  be  in  the  digestive  tract ;  but  the 
severity  of  its  effect  tipon  the  brain  may  be  lessened  by  the  administra- 
tion of  sedatives.  An  excellent  combination  is  that  of  potassium  bromide 
and  antip^Tine.  the  latter  having  both  antispasmodic  and  antip;'.Tetic 
valtie^  and  producing  also  a  tendency  to  perspiration.  A  combination, 
giving  the  emergency  dose  of  potassium  bromide  as  5  to  10  grains  0.30— 
0.60  gm. '  and  of  antip^Tine  as  1^  to  3  grains  0.10-0.20  gm;  according 
to  acre,  is  here  c^iven: 


Gm.  or  c.c. 


R . — Potassii  bromidi,  10 

ABtipyrini,  3 

Glycerini,  10 

Aquse  menthse  piperitse,  q.  s.  ad    60 


(Sijss) 
(gr.  xlv) 
(fdijss) 


Sig. — One-half  to  one  teaspoonful;  may  repeat  in  one  hour. 

If  the  child  does  not  swallow,  as  is  apt  to  be  the  case,  this  must  be 
given  carefully,  a  few  drops  at  a  time. 

A  full  dose  of  castor  oil  should  be  given,  if  swallowing  is  possible,  so 
that  any  irritant  in  the  digestive  tract  may  be  carried  onward.  It  is  not 
advisable  to  give  an  emetic  dtiring  a  spasm,  for  fear  of  vomited  matter 
being  drawn  into  the  trachea 

If  relief  does  not  follow  in  say  half  an  hour,  treatment  coming  tmder 
the  third  heading  may  be  employed,  and  this  will  tisually  be  the  cautious 
use  of  chloroform  by  inhalation,  the  object  being  to  relieve  the  spasm  by 
direct  action  upon  the  brain,  with  which  result  sleep  takes  the  place  of 
the  coma.  From  this  sleep  the  child  may  awake  relieved,  but  in  severe 
cases  it  may  still  remain  in  the  convulsion,  .^^pasms  can  usually  be  con- 
trolled by  chloroform,  but  its  continuous  inhalation  is  in  itself  danger- 
ous, so  that  reliance  for  permanent  relief  must  be  placed  upon  the  other 
measures  that  remove  the  source  of  irritation,  that  relieve  cerebral 
hyperemia,  and  that  lessen  the  irritability  of  the  brain  centres  more 
permanently. 

Chloral  is  often  used  by  recttmi,  in  dose  of  a  few  grains  ( l-oj,  when 
con\iilsions  are  persistent. 

For  treatment  beyond  the  emergency  period,  the  bromide  and  anti 
p^Tine  may  be  contintied  at  the  intervals  necessary  to  prevent  restless- 
ness and  fever.  A  cathartic  shotdd  be  employed,  tmless  pre^■^otlsly  given, 
to  ensure  emptying  of  the  digestive  tract,  where  the  irritation  may  have 
originated.  For  this  purpose  castor  oil  is  our  first  choice,  being  efficient 
and  harmless.     Succeeding  the  hot  bath,  the  child  should  be  v»Tapped 


PLATE    XVI. 


Arterioles 
dilated 


CHLORAL  HYDRATE. 

Dose:  gr.  5-20  (Gin.  .30-1.30). 
Classified  as : 

Hypnotic. 
Narcotic. 
Spinal  depressant. 
Cardiac  depressant. 

Physiologic  action  : 

Locally  applied,  it  is  somewhat 
irritant.  Internally,  it  re- 
sembles chloroform  in  ac- 
tion, except  that  it  is  not 
anesthetic  in  safe  doses. 

Nervous  System. 

Brain.  Depresses  cerebrum. 
Induces  sleep,  but  does  not 
relieve  pain. 

Medulla.  Depresses  respi- 
ratory and  vasomotor  cen- 
ters. 

Spinal  cord.     Depresses  reflex  centers. 

Muscular  System.     Causes  general  muscular  weakness.    Probably 
depresses  muscular  coats  of  the  arterioles  by  direct  action. 

Circulation.     Keduces  arterial  pressure  in  marked  degree. 
Heart.      Depresses  the  cardiac  muscle,  causing  slower  and 

weaker  action. 
Capillary  area.     Dilates  arterioles  by  depressing  vasomotor 

center,  and  probably  also  by  direct  depressant  action  upon 

the  muscular  coats  of  the  vessels. 


Vagus  Center 

Vase  Motor 

Center 
Cervical 
Sympathetic 


^Solar  Plexus 


Depresses  respiratory  center 
Reduced  by  full  doses. 


Respiration. 

Temperature. 

Metabolism.  Destruction  of  proteids  is  increased  with  less  per- 
fect oxidation.  With  prolonged  administration  fatty  degen- 
eration of  various  organs  may  occur. 


The  blue  color  indicates  the  sedative  effects  of  Chloral. 
The  marked  depressant  action  upon  respiratory  and 
vasomotor  centers,  andupon  the  heart,  renders  Chloral 
much  more  dangerous  than  the  bromides,  whose  etfects 
are  similar  in  kind. 


PLATE    XVTI. 


3IOKPHIXE. 


Vagus  Center 

Yaso  Motor 

Center 
Cervical 
Sympathetic 


[For  preparations,  doses,  and  general 
uses  of  Opium,  see  Index  of  Drugs.] 

In  form  of  suuhate,  acetate, 
or  HTDEOCHXOErDE.  Gr.  \-^  (Gni. 
.OOH-.Oloj. 

Classified  as  : 

Anodyne.  Xarcotic. 

Phy.siologic  action  •} 

The  action  of  morphine  is  essen- 
tially that  of  a  central  nerve 
depressant,  the  local  action 
of  the  drug,  wherever  applied, 
being  idmost  nil.  Children  are  very  sensitive  to  this 
drug,  and,  if  needed,  it  should  be  used  in  the  iceakest 
preparations,  and  in  less  than  the  proportional  dose. 

2Servous  System. 

Brain.     Depresses   cerebrum,    especially   in    its 

higher  intellectual  functions. 
Medulla.     Depresses  respiratory  center. 
Spinal  cord.     Does  not  perceptibly  influence 

the  cord. 

XOTE. — In  The  lo-wer  animals  morphine  is  a  stimulant  to  the 
spinal  cord,  but  in  man  marked  depression  of  the  highly 
developed  brain  prevents  any  manifes- 
tation of  spinal  stimulation. 

Nerves.  The  peripheral  nerves 
are  not   affected  by  ordinary 
doses. 
Muscular  System.     Xot  affected  by 

ordinary  doses. 
Circulation.     Xot  much  influenced 
by  ordinary  doses. 
Heart.  Opinions  differ.  Any  in- 
fluence of  a  moderate  dose  must 
be  slight  and  probably  indirect. 
Large  doses  slow  the  heart  by 
stimulating  inhibition. 
Capillary  area.     ZSTot  much 
influenced,  except  that  the  cu- 
taneous area  of  the  head  and 
neck  may  show  dilatation. 
Jtespiration.     Depressed  to  a  degree  corresponding  with 

size  of  dose. 
Eye.     Pupils  contracted  by  central  nerve  influence. 
Digestive  System. 

Stomacli.     Secretion  and  motUity  lessened. 
Intestines.     Peristalsis  is  greatly  diminished. 
Elimination.     Secretions  generally  are  diminished,  except  the  perspiration. 
partly   changed  in  the  system,  but  the  greater  part    is   eliminated  b^ 
intestinal  tract. 

1  For  poisoning  by  Opium  or  Morphine,  see  Table  of  Poisons  and  Antidote; 


Pelvic  Plexus 


The  drug  is 

the  rastro- 


SEDATIVES  225 

in  hot  blankets,  in  order  to  keep  the  blood  toward  the  surface  and  to 
favor  sweating. 

If  dentition  is  found  to  be  abnormal  or  difficult,  and  teeth  are  nearly 
ready  to  appear,  the  gums  may  be  scarified  as  mentioned  before.  But 
cutting  the  gums  over  teeth  that  are  not  likely  to  appear  for  several 
months  is  questionable  practice,  as  the  tissue  will  rapidly  heal,  and  may 
even  present  the  additional  barrier  of  scar  tissue  to  the  later  progress  of 
the  teeth,  ^^^len,  however,  the  gums  are  very  much  swollen  and  con- 
gested, scarification  may  be  advisable  independently  of  the  staie  of 
progress  in  the  eruption  of  the  teeth. 

Other  means  of  accomplishing  the  objects  set  forth  above  may  be 
employed ;  simply  the  outline  of  common  practice  is  here  given.  In  the 
cases  that  present  an  evident  infection,  the  treatment  will,  as  a  matter 
of  course,  vary  according  to  its  nature  and  the  indications  it  furnishes. 

Chloralum  Hydratum.     (Plate  XVI.) 

Chloral  [C2HCI3O — HgO].  Chloral  hydrate  is  a  t\-pical  h}^notic. 
It  is  used  to  induce  sleep  and  to  relieve  convulsions.  It  has  been  sup- 
planted to  a  considerable  extent  by  the  newer  and  safer  hypnotics. 
Care  must  be  taken  not  to  exceed  the  safe  dose,  gr.  5-20  (0.30-1.30 
gm.),  as  it  may  easily  be  poisonous. 

Drugs  having  similar  action: 

Butyl-chloral  Hydrate  (not  official).  Very  similar  to  chloral  in  action. 
Dose,  gr.  5-15  (0.30-1  gm.). 

Sulphonmetlianimi.     Sltlphonal. 

Sulphonethylmethanum.  Trional.  Safer  than  chloral,  but  slower 
in  action.  Trional  is  more  soluble  than  sulphonal,  therefore  usually 
preferred.     Dose  of  each,  gr.  15-30  (1-2  gm.). 

Opium  Alkaloids.     fPlate  XVII.) 

Opium  is  the  concrete  exudation  obtained  by  cutting  the  unripe 
capsules  of  the  opium  poppy,  Papaver  samniferum.  It  contains,  in  its 
fresh,  moist  condition,  at  least  9  per  cent,  of  morphine  (when  dried 
about  12  per  cent.),  besides  a  number  of  other  alkaloids. 

This  drug,  in  its  simple  form,  in  its  preparations,  or  as  represented  by 
its  chief  alkaloids,  morphine  and  codeine,  stands  at  the  head  of  all  agents 
for  the  relief  of  pain.  It  is  the  drug  of  first  importance  among  poisons, 
and,  next  to  alcohol,  is  the  one  most  frequently  used  in  the  way  of  habit. 

\^Tienever,  therefore,  it  is  used,  poisoning  and  habitual  use  must  be 

15 


226  GENERAL  REMEDIES 

guarded  against.  It  must  be  administered  with  some  caution  to  persons 
whose  susceptibihties  are  not  known,  and  as  a  rule  it  should  not  be  given 
to  infants  and  young  children.  The  prominence  of  the  brain  in  child- 
hood makes  the  child  exceedingly  susceptible  to  the  influence  of  this 
drug,  whose  action  is  chiefly  upon  the  brain  and  medulla. 

Fortunately  this  drug  is  little  needed  in  dental  practice,  because  it 
has  little  or  no  local  action.  Its  inutility  to  relieve  pain  by  local  applica- 
tion has  been  discussed  in  connection  with  arsenic.  Practically  the  only 
conditions  in  which  it  is  called  for  are  severe  pulpitis  or  pericementitis, 
which  fail  to  be  relieved  by  ordinary  local  treatment.  Here  a  few 
small  doses  of  the  drug  may  be  given  to  the  patient,  but  it  should  not  be 
prescribed,  for  fear  that  the  relief  obtained  might  lead  to  an  easy  later 
resort  to  the  drug,  with  formation  of  habit.  A  prescription  might  facili- 
tate such  abuse  of  the  remedy.  It  is  also  desirable  for  the  patient  to 
be  ignorant  of  the  name  of  the  drug  given. 

In  the  rare  cases  where  it  becomes  necessary  to  administer  the  drug  to  a 
child,  a  much  smaller  dose  must  be  used  than  that  which  the  rule  would 
allow.*  The  preparation  used  mostly  with  children  is  the  camphorated 
tincture  of  opium,  commonly  known  as  paregoric,  which  contains  only 
0.4  per  cent,  of  opium.  The  rule  should  be  not  to  give  opium  or  morphine 
to  children. 

Persons  who  take  this  drug  habitually  acquire  a  tolerance  for  it,  that 
permits  them  to  take  very  large  doses.  While  the  usual  dose  of  morphine 
is  J  of  a  grain,  a  victim  of  the  habit  may  come  to  use  10,  20  or  30  grains 
daily.  Indeed,  there  is  the  need  of  increasing  doses  in  order  to  maintain 
the  original  efl^ect,  even  where  it  is  taken  for  a  comparatively  short  time 
for  the  relief  of  pain.  This  shows  that  the  tolerance  of  the  drug  begins 
early.  Again,  when  the  system  has  become  accustomed  to  its  action,  it 
is  usually  difficult  to  stop  the  use  of  the  drug  without  some  discomfort  in 
the  way  of  unrest,  that  is  at  once  relieved  by  its  readministration.  On 
these  accounts  it  is  very  easy  to  acquire  the  opium  or  morphine  habit, 
and  very  difficult  to  overcome  it  without  the  fullest  co-operation  of  the 
victim  with  the  medical  adviser;  and  with  the  habit  once  thoroughly 
established,  subjection  to  the  discipline  of  a  hospital  will  usually  be 
required  in  order  to  succeed.  (For  poisoning  by  opium  or  morphine, 
see  Table  of  Poisons  and  Antidotes.) 

Morphina  [Ci7HjgN03  +  H20].  This  alkaloid  was  isolated  from 
opium  and  described  by  Sertiirner  in  1816,  and  was  the  first  to  be  dis- 

*  See  Cowling's  rule  in  chapter  on  Prescription  Writing. 


SEDATIVES  227 

covered  of  the  whole  class  of  alkaloids.  It  has  stood  during  the  years 
since  as  the  most  representative  principle  of  opium;  and,  while  its  action 
varies  slightly  from  that  of  the  whole  opium,  the  uses  of  the  two  sub- 
stances are  identical,  except  that  for  hypodermic  use  a  morphine  salt  is 
always  employed.  Being  a  very  powerful  drug,  morphine  has  to  be 
used  with  caution.  For  its  action  in  detail,  see  Plate  XVII.  Its  official 
salts  are: 

Morphinse  Acetas,  soluble  in  2.25  parts  of  water. 

Morphinae  Hydrochloridum,  soluble  in  17.2  parts  of  water. 

Morphinae  Sulphas,  soluble  in  15.3  parts  of  water. 

The  dose  of  each  of  these  is  gr.  |-— ^  (0.008-0.015),  which  may  be 
increased  slightly; 

Codeina  [C^gHg^NOg  +  IIgO].  Soluble  in  88  parts  of  water.  Codeine 
is  less  powerful  and  depressing  in  action  than  morphine,  and  its  after- 
effects are  less  unpleasant.     Its  official  salts  are: 

Codeinse  Phosphas,  soluble  in  2.25  parts  of  water. 

Codeinse  Sulphas,  soluble  in  30  parts  of  water.  The  dose  of  each  is 
gr.  i-1  (0.015-0.06  gm.). 

Heroine  (not  official).  This  artificial  alkaloid  is  said  to  have  a  more 
depressant  effect  upon  the  respiratory  centre  than  morphine  or  codeine; 
the  dose  is  gr.  yL-i.  (0.005-0.01  gm.). 


CHAPTER  XVIII, 

ELBIIXATIVES. 

A  GROUP  of  functions  that  are  liable  to  disorder  in  connection  with 
any  general  disease,  comprises  those  that  secure  the  discharge  of  waste 
or  used-up  matters  from  the  body.  These  functions  are  called  elimi- 
native,  and  the  organs  chiefly  concerned  in  their  activity  are  the  skin, 
the  kidneys,  the  intestines  and  the  lungs.  Eliminatives  are  those  agents 
that  increase  the  eliminative  activity  of  these  several  avenues  of  excre- 
tion. 

Cathartics  are  agents  that  induce  active  evacuation  of  the  intestines. 
(See  Plate  XVIII.) 

Diuretics  are  agents  that  increase  the  activity  of  excretion  by  the 
kidneys. 

Diaphoretics  are  agents  that  induce  sweating. 

Emetics  are  agents  that  cause  vomiting.  Their  action  is  not  so  purely 
eliminative,  as  vomiting  is  not  a  normal  eliminative  function,  but  rather 
a  result  of  irritation,  or  a  symptom  of  disease.  Their  eliminative  value 
is  seen  mainly  when  a  poison  or  foreign  substance  requires  to  be  removed 
from  the  stomach. 

Expectorants  are  agents  that  increase  the  secretion  of  the  air  passages. 

In  the  study  of  the  general  subject  of  elimination,  we  observe  a  certain 
complementary  relation  between  the  activity  of  the  skin  and  of  the 
kidneys. 

A  certain  amount  of  water,  holding  excretory  matter  in  solution,  passes 
out  of  the  body  daily,  and  while  the  solids  are  separated  from  the  blood 
chiefly  by  the  kidneys,  the  amount  of  water  which  they  excrete  varies 
greatly,  being  influenced  especially  by  the  activity  of  the  skin.  In 
summer,  when  perspiration  occurs  freely,  the  urine  is  scanty  in  quantity 
but  concentrated;  while  in  winter,  when  the  cool  temperature  lessens 
cutaneous  elimination,  the  water  passes  out  mainly  by  the  kidneys, 
causing  a  large  amount  of  diluted  urine.  In  the  application  of  diapho- 
retics and  diuretics  we  should  take  into  account  this  relation,  for  some 
agents  will  act  in  either  way.  For  example,  spirit  of  nitrous  ether,  when 
taken  in  the  evening,  with  the  skin  being  kept  warm  during  the  night, 
will  induce  sweating;  whereas,  when  it  is  given  in  the  morning,  followed 
(228) 


PLATE    XVIII, 

CATHARTICS. 

These  diagrams  are  intended  to  shovr  the  ditTerent 
ways  in  vrhicli  cathanics  may  act. 

It  is  not  possible  to  classify  strictly,  as  the  action  of 
some  is  too  extensive  to  be  limited  to  one  gi-oup  or 
illusti-ated  by  a  single  diagram. 

The  numbers  indicate  the  diagrams  that  represent 
what  is  believed  to  be  the  most  prominent  action  in 
case  of  each  drug,  without  intending  to  show  the  com- 
plete action  in  every  instance. 

[For  preparations  and  doses,  see  Index  of  Drugs.] 

GRorp  A.     LAXATIVES. 

Fruits.     (1) 

Sugar. 

Sulphur. 

Purges  in  small  doses. 

Glycerin  (by  enema).     (2) 

Groi-p  B.     PUKGES. 

Aloe.     (1) 
Mercurials.     (4) 
Oleum  Eicmi.     (4) 
Ehamnus  Frangula.     (1) 
Khamnus  Purshiana.      (1) 
Eheum.     (1) 
Magnesia.      (3) 
Senna.     (I)    (4) 


GRorp  C.     HYDEAGOGUES. 
Salines. 
Magnesii  Citras.     (3) 
Magnesii  Sulphas.      (3) 
Potassii  Bitartras.     (3) 
Potassii  et  Sodii  Tartras.      (3) 
Sodii  Phosphas.     (3) 
Sodii  Sulphas.     (3) 


Elaterintim.     (4) 
Jalapa.     (4) 
Senna.     (1)    (4) 


Group  D.     DEASTICS. 

Colocynthis.      (5) 
Elaterinum.     (3)  (4) 
Jalapa.     (3)   (4) 
Cambogia.     (5) 


Oleum  Tiglii.  (.5) 
Podophyllum.  (5) 
Scammonitim.      (5) 


The  red  color  shows  the  site  of  action,  and  indicates 
stimulation  of  motility  or  secretion. 


3.  Secretion  stimulated. 


PLATE    XVIII. 


CATHARTICS. 

The  natural  provision  for  intestinal  evacuation  in 
eludes  three  factors : 

First.  A  certain  amount  of  indigestible  matter  in 
the  food. 

Second.  Peristaltic  motion  from  the  stomach  down- 
ward. 

Third.     A  certain  degree  of  fluidity  of  contents. 

A  decrease  of  any  one  factor  tends  to  constipation, 
while  an  increase  tends  to  diarrhoea. 

Cathartics  act  by  influencing  these  several  factors. 

Laxative  foods  act  by  reason  of  their  indigestible 
residue.  Almost  any  cathartic  may  have  simply  a 
laxative  effect  when  used  in  small  doses. 

Purges,  by  their  irritating  action,  stimulate  peris- 
talsis, the  milder  ones  acting  mainly  upon  the  large 
intestine  (1).  Some,  in  large  doses,  approach  drastics 
in  severity  of  action  (5).  The  absence  of  bile  dimin- 
ishes the  activity  of  podophyllum,  jalapa,  rheum, 
senna,  and  scammonium. 

Hydragogues  act  in  two  ways : 

The  less  irritating  salines  cause  a  marked  increase 
of  fluid  by  determining  a  flow  of  serum  from  the  blood 
into  the  intestine  (3).  A  low  blood-pressure  diminishes 
their  activity. 

The  more  irritating  hydragogues  stimulate  very 
promptly  peristalsis  of  the  small  intestine,  with  the 
result  that  the  fluid  contents  are  hurried  onward  and 
absorption  is  lessened  (4).  Secretion  also  may  be  in- 
creased.    Copious  liquid  stools  result. 

Drastics  stimulate  powerfully  the  peristaltic  move- 
ment of  the  whole  ti-act  (5),  causing  prompt,  frequent 
stools,  with  severe  griping.  In  large  doses  they  act  as 
irritant  poisons,  and  may  cause  contractions  in  the 
gravid  uterus. 

Cholagogues  favor  the  flow  of  bile  into  the  duodenum, 
probably  through  the  increased  peristalsis.  The  in- 
fluence of  cathartics  upon  the  function  of  the  liver 
seems  uncertain  and  indirect. 


The  red  color  shows  the  site  of  action,  and  indicates 
stimulation  of  motility  or  secretion. 


ELIMINA  TIVES  229 

by  exposure  to  a  cool  out-of-door  temperature,  it  will  act  as  a  diuretic. 
To  some  extent  bowel  activity  also  may  relieve  the  kidneys.  We  have, 
therefore,  two  resources  in  the  direction  of  vicarious  elimination  when 
the  kidneys  are  disabled — viz.,  by  catharsis  and  by  diaphoresis ;  though 
they  are  only  substitutes  and  much  less  efficient. 

The  lungs  are  concerned  only  with  the  elimination  of  volatile  sub- 
stances. 

DIURETICS. 

Diuretics  increase  activity  of  the  kidneys  in  several  ways. 

1.  Some  alter  the  composition  of  the  blood  by  increasing  its  salinity. 
The  potassium  salts  especially  act  in  this  w^ay.  Potassium  is  less  needed 
by  the  system  than  sodium;  therefore  a  moderate  dose  means  an  excess 
in  the  blood,  which  naturally  passes  out  by  the  kidneys,  carrying  con- 
siderable w^ater  with  it.  This  explains  why  potassium  salts  are  diuretic 
while  sodium  salts  are  not.  The  most  valuable  for  this  purpose  are  the 
following: 

Potassii  Acetas.    This  salt  is  deliquescent. 

Potassii  Citras.    This  salt  is  deliquescent. 

Potassii  Bitartras.    Cream  of  Tartar. 

Potassii  Nitras.     Nitre.     Saltpetre. 

(For  doses  and  uses,  see  Index  of  Drugs.) 

Of  these  potassium  salts,  the  acetate,  citrate  and  bitartrate  are  harm- 
less when  given  properly  diluted,  and  their  use  may  be  continued  indefi- 
nitely. The  bitartrate  is  cathartic  when  given  in  large  dose.  The  nitrate 
is  used  with  caution,  as  it  is  believed  to  be  more  stimulating  to  the  kidney. 

2.  Another  class  of  diuretics  act  chiefly  by  increasing  arterial  pressure. 
In  many  cases  where  elimination  is  deficient,  it  is  because  the  circula- 
tion is  weak  and  the  arterial  pressure  low;  in  fact,  the  balance  of  blood 
pressure  has  been  transferred  from  the  arterial  to  the  venous  side,  which 
causes  dropsy  or  edema.  The  best  kind  of  diuretic  here  may  be  an 
agent  that  restores  the  balance  of  pressure  to  the  arterial  side,  even 
though  it  does  not  directly  stimulate  the  kidney  structure.  The  follow- 
ing drugs  act  in  this  way: 

Digitalis,  which  is  typical  of  its  group,  which  includes: 

Strophanthus. 

Convallaria.    Lily  of  the  Valley. 

Sparteinse  Sulphas. 

Scilla.    Squill. 

(For  preparations  and  doses  of  these,  see  Index  of  Drugs.) 


230  GENERAL  REMEDIES 

3.  Still  other  diuretics  act  by  stimulating  the  secreting  structure  of  the 
kidney,  leading  to  a  better  excretion  of  solids.  These  are  sometimes 
called  stimulating,  or  specific,  diuretics. 

Examples  of  this  class  are: 

Spiritus  iEtheris  Nitrosi.  Spirit  of  Nitrous  Ether.  Sweet  Spirit 
of  Nitre. 

Buchu. 

Caffeina. 

Cubeba.     Cubeb. 

Oleum  Juniperi.    Oil  of  Juniper  Berries. 

Oleum  Terebinthinse.    Oil  of  Turpentine. 

Potassii  Nitras. 

Theobromine  (not  official). 

Uva  Ursi. 

(For  preparations  and  doses  of  these,  see  Index  of  Drugs.) 

The  above  division  into  classes  is  convenient,  but  not  absolute,  as  some 
diuretics  act  in  more  than  one  way.  Such  are  classed  according  to  their 
more  prominent  action. 

DIAPHORETICS. 

The  agents  that  induce  sweating  are  well  represented  by  the  following; 

Spiritus  ^theris  Nitrosi  (with  skin  kept  warm). 

Pilocarpinse  Hydrochloridum. 

Pilocarpinae  Nitras. 

(For  doses  and  uses,  see  Index  of  Drugs.) 

Heat  in  form  of  hot-air  cabinet  bath,  hot-bed  air  bath,  hot  mustard 
foot  bath,  and  hot  teas  of  various  kinds  drunk  in  good  quantity,  is  a 
most  important  and  probably  the  most  reliable  agency  for  inducing 
sweating. 

EMETICS. 

The  agents  that  induce  vomiting  act  either  by  irritating  the  mucous 
membrane  of  the  stomach,  causing  reflex  contraction  of  stomach,  dia- 
phragm, and  abdominal  muscles,  or,  by  acting  directly  upon  the  vomiting 
centre  in  the  medulla,  they  stimulate  the  same  motor  activities. 
The  following  act  reflexly  by  irritating  the  stomach: 
Sinapis.  Mustard.  The  ordinary  ground  mixture  of  black  and 
white  mustard  seed  is  employed,  a  tablespoonful  or  less  stirred  up  in  a 
glass  of  cold  water. 


ELIMINATIVES  231 

Ipecacuanha. 

Zinci  Sulphas.    Sulphate  of  Zinc. 

Cupri  Sulphas.    Sulphate  of  Copper. 

Antimonii  et  Potassii  Tartras.    Tartar  Emetic. 

The  first  three  are  commonly  used,  being  reliable  and  safe.  Sul- 
phate of  copper  is  more  irritating,  therefore  capable  of  doing  harm. 
Tartar  emetic  is  also  very  depressing,  and  has  often  caused  poisoning. 
'  (For  preparations  and  doses  of  these,  see  Index  of  Drugs.) 

Common  salt  and  powdered  alum  also  are  useful  emetics. 

Apomorphinae  Hydrochloridum.  Hydrochloride  of  Apomorphine. 
This  is  an  artificial  alkaloid  derived  from  morphine.  As  it  acts  upon 
the  vomiting  centre,  it  may  be  given  hypodermically  in  cases  of  poison- 
ing by  opium  or  other  narcotics,  where  the  patient  does  not  swallow. 
The  dose  hypodermically  is  gr.  -^  (0.006  gm.). 

(See  Index  of  Drugs.) 

The  use  of  emetics  has  lessened  somewhat  since  washing  out  of  the 
stomach  (lavage)  has  become  such  a  common  procedure.  The  latter 
has  the  advantages  of  emptying  the  stomach  without  any  delay  and 
permitting  a  thorough  washing  of  its  walls. 

The  uses  of  syrup  of  ipecacuanha  with  children  merit  special  atten- 
tion. In  cases  of  spasmodic  croup  it  is  employed,  in  emetic  dose,  for  the 
purpose  of  securing  complete  relaxation  of  the  respiratory  apparatus, 
with  relief  of  the  spasm  in  the  larynx.  Also  in  the  treatment  of  bronchitis 
in  children  too  young  to  expectorate,  its  emetic  action  is  employed  in 
order  to  expel  m.ucus  from  the  air  passages,  where  its  accumulation 
interferes  with  breathing  and  provokes  coughing.  For  both  purposes 
mentioned  syrup  of  ipecacuanha  is  given  in  doses  of  one-half  to  one 
teaspoonful  (2-4  gm.),  repeated  in  half  an  hour  if  necessary,  the  pur- 
pose being  to  induce  vomiting. 


EXPECTORANTS. 

Expectorants  increase  the  secretion  of  the  air  passages.  Some  of  the 
emetic  drugs,  and  especially  the  following,  may  be  expectorant  in  smaller 
doses : 

Ipecacuanha.     Ipecac. 

Antimonii  et  Potassii  Tartras.     Tartar  Emetic. 

(For  preparations  and  doses,  see  Index  of  Drugs.) 

Ammonia  and  ammonium  preparations  are  largely  eliminated  by  the 
air  passages,  and  they  at  the  same  time  stimulate  the  mucous  secretion. 


-32  GEXERAL   REMEDIES 

The  chief  ones  of  vah.e  are  the  ,™  following,  the  first  of  which  is  also  a 
genera  stimulant,  and  nsed  on  this  account  in  the  tnore  depress^ 
respiratory  diseases,  such  as  pneumonia.  epressing 

Ammonii  Carbonas. 

Ammonii  Chloridum. 

Other  expectorants,  stimulating  in  nature,  include 

Cubeba.     Cubeb. 

SciUa.    Squill. 

(For  preparations  and  doses,  see  Index  of  Drugs.) 


CHAPTER    XIX. 

DENTISTRY  DURING  PREGNANCY. 

The  decision  of  the  question  as  to  performing  dental  operations 
during  gestation  must  usually  rest  upon  the  combined  opinion  of  family 
physician  and  dentist.  It  is  easy  to  formulate  rules  of  practice,  but 
these  may  just  as  easily  be  disregarded  in  the  presence  of  an  urgent 
condition.  It  must  always  be  remembered  that  gestation  is  usually 
a  normal,  physiologic  process,  which  should  permit  liberty  of  treatment 
within  sensible  limits,  instead  of  imposing  too  strict  limitations. 

The  factors  that  form  the  basis  for  the  exercise  of  caution  are : 

1.  Increased  nervous  susceptibility  of  the  pregnant  woman,  particu- 
larly in  the  early  months. 

2.  Danger  of  disturbance  of  the  process  of  gestation  through  shock 
or  violence. 

There  may  also  be  noted  the  prevalent  belief  that  strong  impressions 
upon  the  senses  may  be  the  cause  of  birthmarks. 

This  belief,  though  it  has  the  support  of  some  authorities,  cannot 
be  given  any  physiologic  basis.  The  fact  that  no  nervous  connection 
exists  between  mother  and  embryo  weighs  heavily  against  it;  for  that 
fact  requires  the  assumption  that  some  blood  condition  of  the  mother 
is  capable  of  influencing  in  a  peculiar  way  some  particular  embryonic 
tissue;  in  other  words,  to  exert  a  selective  influence. 

Assuming  such  an  improbability,  it  still  could  not  be  believed  that 
tissue  once  normally  formed  can  be  subject  to  such  influence;  therefore, 
it  is  safe  to  state  that  any  detrimental  impression  can  be  potent,  if  at 
all,  only  during  the  early  weeks  of  gestation,  the  time  of  conception 
doubtless  being  the  most  impressionable  period. 

The  period  of  greatest  liability  to  possible  dangers  of  this  kind  being 
then  at  a  time  when  it  is  as  yet  uncertain  whether  pregnancy  exists,  it, 
indeed,  being  oftentimes  unexpected,  it  is  evident  that  we  can  exercise 
practically  no  control  in  this  matter;  and  for  the  dental  practitioner  to 
observe  the  general  rules  to  be  given  later,  should  suflfice  as  far  as  he 
can  be  concerned. 

Coming  to  the  practical  question  of  dental  operations,  we  recognize 

(233) 


234  General  remedies 

certain  periods  of  greater  susceptibility  to  disturbance.  The  first 
three  months  constitute  the  period  of  greatest  nervous  instabihty,  as 
shown  by  reflex  vomiting,  which  occurs  in  the  healthiest  women  as 
well  as  in  the  less  vigorous.  The  system  is  accommodating  itself  to  the 
new  order  of  affairs.  Certain  organs  are  undergoing  change  to  ac- 
commodate new  or  increased  function.  Latent  weakness  of  organs 
is  apt  to  become  manifest.  It  is  the  period  which  usually  determines 
whether  accommodation  and  compensation  can  sufficiently  occur,  for  it 
is  the  period  of  most  frequent  failure;  which  is  to  say  that  abortion 
occurs  more  frequently  during  the  first  three  months. 

This  period  once  passed  without  accident,  health  and  vigor  improve, 
so  that  after  the  fourth  month  the  state  of  health  is  often  the  best  ever 
experienced.  This  satisfactory  status  continues  to  the  end  of  gestation; 
except  that  during  the  last  two  months  there  is  danger  of  premature 
labor  being  induced  through  shock  or  violence. 

These  considerations  lead  us  to  divide  gestation,  for  our  present  pur- 
pose, into  three  periods,  as  follows: 

1.  First  three  months— the  susceptible  and  accommodative  period. 

2.  Fourth  to  seventh  month  inclusive — the  period  of  vigorous  health. 

3.  Last  two  months — the  period  of  increasing  discomfort. 

During  the  first  period  any  considerable  operation  should  be  avoided, 
unless  absolutely  necessary.  Prolonged  filling  operations,  or  extrac- 
tion of  a  tooth,  had  better  be  postponed  until  after  this  unstable  period 
of  accommodation  and  great  susceptibility.  But  it  must  be  plain  that 
even  the  extraction  of  a  tooth  may  occasion  less  disturbance  than  tooth- 
ache prolonged  through  several  days  with  sleepless  nights.  In  case 
of  an  extraction  being  positively  necessary,  an  anesthetic  may  be  used 
at  the  discretion  of  the  family  physician. 

From  the  foregoing  it  appears  that  the  time  of  choice  for  dental 
operations  lies  within  the  second  period,  and  preferably  during  the 
fifth  and  sixth  months.  At  this  time  the  general  health  is  at  its  best 
and  the  danger  of  disturbing  gestation  at  its  minimum.  There  is  no 
good  reason  why  any  necessary  dental  work  should  not  be  done  during 
several  months  at  this  time.  There  should  be  every  care  taken  to  avoid 
the  infliction  of  pain,  and  short  sittings  should  be  the  rule.  Anesthesia 
of  short  duration  is  admissible  when  necessary,  the  choice  of  agent 
to  be  left  to  the  family  physician.  It  should,  however,  be  noted  that 
all  during  gestation  there  is  an  essential  tendency  to  toxemia  upon  slight- 
est provocation,  because  of  the  extra  demand  upon  nutrition  and  elimi- 
nation.    It  is  a  question,  therefore,  whether  any  anesthetic  should  be 


DENTISTRY  DURING  PREGNANCY  236 

used  that  will  increase  this  tendency  or  add  to  its  results.  The  exclu- 
sion of  air  during  the  induction  of  anesthesia,  as  is  common  with  nitrous 
oxide,  should  be  avoided,  as  directly  contributing  to  auto-intoxication, 
and  this  means  that  inhalers  that  do  not  allow  free  accesss  of  air,  or 
those  that  require  the  breathing  again  of  expired  air,  should  not  be 
used. 

In  the  third  period  a  restrained  posture  in  the  dental  chair  for  any 
length  of  time  may  mean  serious  discomfort.  Add  to  this  the  danger, 
though  slight,  of  provoking  premature  labor,  and  we  are  brought  to 
the  conclusion  that  dental  operations  should  be  avoided  during  the  last 
two  months,  if  possible.  Where  dental  work  seems  necessary  during 
this  period,  the  operator  should  consult  the  family  physician  before 
undertaking  the  same;  for  it  may  be  that  there  are  unfavorable  points 
in  the  patient's  condition  that  are  known  only  to  her  physician. 

Care  of  the  Mouth  during  Pregnancy.  Because  of  the  abundantly  ob- 
served fact  that  caries  of  the  teeth  makes  rapid  progress  in  the  teeth  of 
pregnant  women,  care  of  the  mouth  with  a  view  to  prevention  of  caries 
becomes  very  important. 

It  was  earlier  believed  that  the  tooth  structure  suffered  a  change  by 
giving  up  some  of  the  mineral  salts  to  meet  the  needs  of  the  growing 
embryo.  If  this  were  true  it  would  seem  that  Nature  had  shown  her- 
self seriously  at  fault  in  failing  to  provide  sufficiently  for  the  assimilation 
of  materials  that  are  very  abundant  in  the  foods  commonly  taken.  How- 
ever, it  has  been  shown  by  Black*  that  the  teeth  of  females  during  the 
period  of  life  when  child-bearing  occurs,  average  slightly  harder  and 
denser  than  the  teeth  of  males  during  the  same  period  of  life;  and  the 
conclusion  follows  that  the  prevalence  of  caries  must  be  explained  in 
some  other  way. 

When  we  consider  the  active  part  that  acids  take  in  the  production 
of  caries,  it  is  only  necessary  to  point  out  that  the  usual  vomiting  of 
pregnancy,  which  occurs  during  the  first  three  months,  brings  acid 
stomach  contents  daily,  and  oftener,  into  the  mouth  and  in  contact  with 
the  teeth,  and  we  have  the  basis  of  a  rational  explanation  of  the  rapid 
progress  of  caries.  Also,  with  the  attention  fixed  upon  other  matters, 
and  with  more  or  less  general  indisposition,  the  teeth  are  very  likely  to 
be  neglected  just  at  a  time  when  they  need  extra  care. 

Upon  the  basis  of  this  explanation  the  prophylaxis  will  be  simple 
and  efficient.  If  we  are  in  a  position  to  advise  early,  education  of 
the  patient  comes  first;  then  the  simplest  kind  of  an  alkaline  mouth- 
*  Dental  Cosmos,  May,  1895. 


236  GENERAL  REMEDIES 

wash,  such  as  lime-water  or  saturated  solution  of  borax  or  of  sodium 
bicarbonate,  used  freely  at  frequent  intervals  and  immediately  after  every 
occurrence  of  vomiting,  and  continued  during  the  early  months,  ought 
to  suffice  in  a  special  way.  The  usual  directions  as  to  general  care  of 
the  mouth  and  teeth  will,  of  course,  be  emphasized. 

Unfortunately,  even  the  physician  is  not  consulted  in  the  average  case 
until  the  period  most  important  for  prophylaxis  is  past;  therefore,  every 
suitable  opportunity  of  educating  mothers  and  those  likely  to  be  mothers, 
upon  these  points,  should  be  improved. 


PART  IV. 

CHAPTER   XX. 

PRESCRIPTION  WRITING. 

The  writing  of  prescriptions  is  an  art  that  requires  practice  for  its 
perfection.  Its  basis  must  be  a  certain  attainment  in  the  knowledge  of 
drugs,  their  activities  and  their  doses,  as  related  to  their  selection  for 
certain  diseases ;  also  of  their  physical  and  chemical  qualities  as  related 
to  form  of  administration  and  possible  combination  with  other  substances. 
While  it  is  easy  to  order  a  simple  solution  of  a  common  substance,  the 
forming  of  an  original  compound  prescription,  to  suit  a  special  condition, 
calls  for  the  exercise  of  as  much  and  as  varied  ability  as  does  almost 
any  function  that  pertains  to  the  physician's  duties.  After  the  prescriber 
comes  to  a  point  in  experience  when  his  remedies  are  familiar  and  his 
own  combinations  of  them  are  established,  their  prescription  by  him  in 
any  modification  to  suit  special  cases  is  comparatively  easy;  but  to  the 
beginner  in  practice,  nothing  is  much  more  difficult  than  to  write  origmal 
prescriptions  with  any  degree  of  confidence. 

The  art  of  prescribing  is  quite  ancient,  ha\T[ng  been  employed  first  by 
the  physician  to  guide  his  assistant  in  preparing  his  medicinal  mixtures, 
the  office  of  physician  having  included  also  that  of  apothecary.  To-day, 
with  pharmacy  developed  into  a  distinct  profession,  our  prescriptions  are 
intended  to  direct  the  preparation  of  a  medicine  to  be  supplied  by  the 
pharmacist  to  the  patient,  to  be  used  according  to  the  written  directions 
of  the  prescriber.  There  is  a  marked  contrast  between  ancient  and 
modern  prescriptions,  in  respect  to  greater  definiteness  and  simphcity. 
Reference  to  the  works  of  Fallopius,  w^ho  lived  1523-1562,  furnishes  an 
illustration  of  complexity  in  prescribing,  in  a  formula  written  by  him, 
which  contains  thirty-two  different  ingredients. 

Since  the  sixteenth  century  we  have  learned  enough  about  the  human 
body  and  its  diseases  to  know  that  it  is  unnecessary  to  exliaust  our 
materia  medica  in  prescribing  for  any  one  disease,  and,  with  a  more 
definite  knowledge  of  the  action  and  effects  of  drugs,  we  find  that  only 

(237) 


238  PRESCRIPT lOX   WRITING 

a  few  agents  can  be  employed  to  real  profit  in  meeting  a  pathologic  con- 
dition. Hence,  our  prescriptions  of  to-day  approach  the  extreme  of 
simplicity,  usually  containing  not  more  than  three  or  four  ingredients. 
The  term  "shotgun"  prescription  is  derisively  applied  now  to  a  formula 
containing  a  large  number  of  substances,  upon  the  supposition  that  it  is 
expected  to  hit  somewhere.  A  certain  idea  of  definiteness,  however,  is 
traced  back  to  Asclepiades  (about  100  B.C.),  who  is  credited  with  for- 
mulating the  object  of  treatment  to  be  to  cure  quickly,  safely  and  pleas- 
antly (curare  ciio,  tide  et  jucunde),  and  this  has  led  to  a  recognition  of  the 
■typical  formula  as  consisting  of  four  ingredients,  each  related  to  this 
object  and  named  accordingly. 

1st  ingredient — Basis  or  base.  Cure. 

2d  ingredient — Adjuvant  or  auxiliary.  Quickly. 

3d  ingredient — Corrigent  or  corrective.  Safely. 

4th  ingredient — Excipient  or  vehicle.  Pleasantly. 

"\Miile  these  terms  aid  us  in  comprehending  the  full  purpose  of  pre- 
scription T\Titing,  it  must  be  understood  that  a  formula  need  not  contain 
more  than  one  active  agent,  and  that  any  combination  of  medicines 
should  always  be  based  upon  definite  objects  to  be  attained,  either  as  to 
form  or  utility. 

Several  definitions  are  here  necessary  to  the  proper  understanding  of 
terms : 

A  formula  consists  of  the  names  and  quantities  of  ingredients  that  are 
to  enter  into  a  medicinal  preparation,  with  directions  for  compounding 
them. 

An  official  formula  is  one  that  is  contained  in  the  United  States  FJiar- 
7nacop(£ia. 

An  extemporaneous  formula  is  one  that  is  made  up  by  the  prescriber 
for  the  occasion. 

A  formula  may  be  simple,  containing  only  one  medicinal  agent,  or 
compound,  containing  two  or  more  active  ingredients. 

A  prescription  consists  of  the  formula  for  the  preparation  of  a  medi- 
cine, to  which  is  added  the  directions  for  its  use  in  a  given  case. 

Whenever  a  prescription  orders  an  official  formula,  only  the  title  of 
the  latter  need  be  given,  without  naming  the  ingredients.  Thus,  Dover's 
powder  (containing  opium  1  part,  ipecacuanha  1  part,  and  sugar  of  milk 
8  parts)  is  official  under  the  title  Puhis  Ipecacuanhse  et  Opii.  In  pre- 
scribing, therefore,  it  is  only  necessary  to  write — 

R. — Pulveris  Ipecacuanhse  et  Opii  (quantity), 


PRESCRIPTION  WRITING  239 

instead  of  naming  each  ingredient  and  its  quantity,  as  would  be  necessary 
if  it  were  not  official. 

A  pharmacopceia  is  a  book  of  national  authority,  containing  a  list  of 
recognized  drugs  and  preparations,  with  their  descriptions,  tests  and 
formulas.  It  is  the  authoritative  standard  for  the  purity  and  strength 
of  drugs  and  for  uniformity  of  preparations.  It  now  gives  the  average 
dose  of  each  internal  remedy,  but  it  includes  nothing  of  the  actions  and 
uses  of  drugs.  While  in  most  countries  the  pharmacopoeias  are  under 
governmental  control,  the  United  States  Pharmacopceia  is  under  the 
control  of  the  professions  of  medicine  and  pharmacy,  and  is  revised  by 
their  direction  every  ten  years. 

The  points  involved  in  making  a  compound  prescription  are: 

(a)  Selection  of  the  drugs  to  be  employed. 

(6)  Their  solubility  (unless  powder  form  is  desired). 

(c)    Their  compatibility  in  the  desired  combination. 

(<^)  Their  doses. 
These  points  will  be  considered  separately. 


SELECTION  OF  INGREDIENTS. 

Selection  of  drugs  must  depend  primarily  upon  a  knowledge  of  the 
conditions  to  be  treated  and  acquaintance  with  the  power  of  drugs  to 
remedy  the  same,  and  secondarily  upon  the  practicability  of  their 
administration  or  their  combination  with  other  necessary  ingredients. 
Some  drugs,  by  reason  of  their  chemical  properties,  must  always 
be  given  alone  ;  others  cannot  be  brought  into  solution ;  others  are 
poisonous. 

Under  this  heading  the  main  objects  of  combining  medicines  may  be 
stated  as  follows: 

1.  To  secure  the  combined  effects  of  similarly  acting  medicines — e.  g., 

strychnine,  as  a  bitter  tonic,  may  be  combined  with  iron  as  a 
general  restorative  tonic. 

2.  To  secure  the  effects  of  medicines  that  have  distinct  and  unrelated 

actions — e.  g.,  in  the  official  Pilulse  aloes  et  ferri,  the  aloes  is 
a  cathartic  and  the  iron  a  restorative  to  the  blood. 

3.  To  secure  the  opposite  effects  of  medicines. 

(a)  By  correcting  or  modifying  the  action  of  the  base,  as  when  tincture 
of  aconite  is  added  to  tincture  of  iodine  to  render  its  action 
milder. 


240  PRESCRIPTIOX   WPJTIXG 

(6)  By  rendering  the  action  of  the  base  safer.  Here  antagonism  of  drug 
actions  is  made  use  of,  as  in  the  common  addition  of  atropine  to 
morphine  in  order  to  counteract  its  depressant  action  upon  the 
respiratory  centre. 

4.  To  secure  a  suitable  form. 

(a)  By  the  use  of  special  solvents  to  obtain  a  liquid  form  of  an  otlier- 
wise  insoluble  substance — e.  g.,  salicylic  acid  requires  SOS  parts 
of  water  to  dissolve  it,  but  if  borax  is  first  dissolved  to  saturation 
saHcylic  acid  is  soluble  in  less  than  100  parts  of  the  solution. 

(h)  By  securing  a  finely  divided  state  of  the  drug.  Sugar  of  milk  is 
often  used,  on  account  of  the  hardness  of  its  crystals,  to  rub  up 
other  drugs  into  very  fine  particles,  as  in  tablet  triturates. 

(c)  By  obtaining  a  mixture  that  is  agreeable  to  the  sight  and  pleasant 
to  the  taste. 

5.  To  obtain  a  combination  to  act  as  a  new  substance. 

(a)  Dover's  povrder  contains  opium  and  ipecacuanha,  the  combina- 
tion haAing  a  diaphoretic  eft'ect  not  possessed  to  any  degree  by 
the  separate  drugs. 

(b)  Chemicals  are  sometimes  combined  in  order  to  obtain  a  new  definite 
compotnid  by  their  reaction. 

6.  Tor  preservation  of  the  medicine. 

Alcohol,  glycerin  or   stigar  in  large  c^uantity,  may  serve  not  only 

as  excipients.  but  also  to  preserve  medicinal  preparations  which 

are  to  be  kept  for  some  time.    It  is  not  considered  good  pharmacy 

to  add  antiseptics  to  medicines. 

Sugar  in  diltite  sohition  will  ferment  easily  at  a  summer  temperature, 

but  when  used  in  strong  solution  (70  to  So  per  cent.),  as  in  some  of  the 

official  syrups,  it  will  preserve  the  preparation  indefinitely. 

Knowing  what  substances  we  vvish  to  combine,  the  form  of  the  com- 
bination must  be  determined,  whether  powder,  pill,  capsule,  or  liquid. 
For  the  first  three  the  quality  of  solubility  is  unimportant,  but  when  the 
medicine  is  to  be  in  liquid  form,  solution  must  be  secured  whenever  it  is 
possible. 

SOLUBILITY. 

The  prescriber  should  familiarize  himself  with  the  solubility  of  each 
of  the  solid  substances  that  he  is  likely  to  tise,  for  the  reason  that  no  rtile 
of  solubility  can  be  laid  down.  A  few  general  statements,  however,  may 
serve  some  purpose. 

It  is  found  that  salts  are  ustiallv  jnore  soluble  in  icater  than  in  alcohol. 


PRESCRIPTION  WRITING 


241 


Substances  that  are  soluble  in  water  are  quite  likely  to  be  soluble  in 
glycerin. 

Gums  and  mucilages  are  soluble  in  water,  but  insoluble  in  alcohol. 

Resins  and  resinous  substances  are  soluble  in  alcohol,  but  insoluble  in 
water. 

Substances  that  are  soluble  in  alcohol  are  generally  soluble  also  in 
ether,  chloroform  and  benzin. 

Water  stands  as  the  most  universal  solvent  and  vehicle  in  medicinal 
combinations. 

Alcohol  is  most  valuable  in  preparations  that  are  to  be  kept  for  a  time, 
because  of  its  preservative  power  in  addition  to  being  an  excellent  sol- 
vent. 

Glycerin  has  solvent  powers  similar  to  those  of  water,  and  it  is  also  a 
good  preservative. 

With  some  drugs  it  is  necessary  to  add  an  acid,  and  with  others  an 
alkali,  to  aid  solution — e.  g.,  borax  will  aid  solubility  in  water  of  both 
benzoic  and  salicylic  acids;  on  the  other  hand,  quinine  sulphate  has  its 
solubility  in  water  increased  by  the  addition  of  sulphuric  acid. 

A  number  of  substances  can  be  conveniently  handled  in  saturated 
solution,  some  to  be  used  in  full  strength,  others  requiring  dilution.  The 
following  table  furnishes  the  degree  of  solubility,  and  also  the  approx- 
imate percentage  strength  of  saturated  aqueous  solutions,  of  a  number 
of  the  most  commonly  used  substances: 


Percentage  strength 

Soluble  in  parts 

of  saturated 

of  water. 

solution. 

Acid,  benzoic 281 

0.35  percent. 

Acid,  boric 

.       18 

5.5 

Acid,  carbolic  (phenol) 

.       20 

5 

Acid,  gallic     . 

.       84 

1.19 

Acid,  salicylic 

.     308 

0.32 

Acid,  tannic    .  ' 

0.34 

300 

Alum     . 

9 

11 

Ammonium  carbonate     . 

4 

25 

Ammonium  chloride 

2 

50 

Antipyrine     . 

1 

100 

Betanaphtol  . 

.     950 

0.1 

Caffeine 

.       46 

2.17       " 

Caffeine,  citrated     . 

f       4* 
1      25 

25            " 

4 

*  Citrated  caffeine  with  about  4  parts  of  hot  water  forms  a  clear,  syrupy  solution 
which,  when  diluted,  deposits  caffeine,  which  redissolves  with  25  parts  of  water. 

16 


242 


PRESCRIPTION    WRITING 


Chloroform 

Cocaine  hydrochloride     . 

Codeine  sulphate   ... 

Copper  sulphate 

Corrosive  sublimate 

Creosote         .... 

Iodine  .... 

Lead  acetate  .... 

Magnesium  oxide    . 

Magnesium  sulphate 

Morphine  acetate   (fresh) 

Morphine  sulphate 

Potassium  bicarbonate 

Potassium  bitartrate 

Potassium  bromide 

Potassium  carbonate 

Potassium  chlorate 

Potassium  iodide  . 

Potassium  nitrate  . 

Potassium  permanganate 

Potassium  sulphate 

Quinine  bisulphate 

Quinine  sulphate    . 

Resorcinol     .... 

Saccharine  (benzosulphinide)   . 

Silver  nitrate 

Sodium  benzoate     . 

Sodium  bicarbonate 

Sodium  borate 

Sodium  bromide 

Sodium  carbonate  (monohydrated) 

Sodium  chloride 

Sodium  thiosulphate  (hyposulphite) 

Sodium  salicylate     . 

Strychnine  sulphate 

Sugar     ..... 

Thymol  .... 

Zinc  acetate  .... 

Zinc  chloride 

Zinc  sulphate  ... 


s 

Dluble  in  parts 
of  water. 

.     200 

Percentage  strength 

of  saturated 

solution. 

0.5  per  cent. 

0.4 

250 

a 

23 

4.3 

2.2 

45.4 

li 

.       13 

7.7 

« 

.     140 

0.71 

(( 

.  5000* 

2 

50 

it 

.       15t 

0.85 

117 

>i 

2.5 

40 

« 

.       15.3 

6.5 

(( 

3 

33 

« 

.     200 

0.5 

« 

1.5 

66 

it 

0.91 

109 

it 

.       16 

6.25 

(I 

0.7 

133 

it 

3.6 

28 

ft 

.       15 

6.6 

it 

9 

11 

it 

8.5 

11.7 

ti 

.     720 

0.14 

ti 

0.5 

200 

it 

.     250 

0.4 

(t 

0.54 

200 

it 

1.6 

62.5 

it 

12 

8.3 

it 

20.4 

5 

it 

1.7 

60 

it 

3 

33 

it 

2.8 

36 

it 

0.35 

286 

it 

0.8 

125 

it 

31 

3.2 

it 

0.5 

200 

a 

1100 

0.09 

it 

2.5 

40 

it 

0.3 

333 

it 

0.53 

188 

a 

*  The  solubility  of  iodine  is  increased  by  the  addition  of  potassium  iodide,  as  in 
Lugol's  solution. 

t  With  15  parts  water  magnesia  does  not  dissolve,  but  forms  the  gelatinous  milk 
of  magnesia. 


PRESCRIPTION    WRITING 


243 


The  following  table  is  of  convenience  in  preparing  any  solution  of  a 
desired  percentage  strength.  Quantities  are  expressed  in  the  old  system 
of  measures,  with  metric  equivalents  also  given.  The  result  is  not 
absolutely  exact,  but  sufficiently  so  for  practical  purposes : 


Amount  of  solution 

Quantity  of  drug  needed  for 

wanted. 

%%  strength. 

1%  strength.      2%  strength,   i  5%  strength. 

10%  strength. 

1  fluidrachm 

(4  c.c). 

j%  grain 
(0.02  gm.). 

f  grain 
(0.04  gm.). 

1^  grains 
(0.08  gm.). 

3  grains 
(0.20  gm.). 

6  grains 
(0.40  gm.). 

1  fluidounce 
(30  c.c). 

2J  grains 
(0.15  gm.). 

5  grains 
(0.30  gm.). 

10  grains 
(0.60  gm.). 

24  grains 
(1.50  gm.). 

48  grains 
(3  gm.). 

1  pint 
(  500  c.c). 

40  grains 
(2.5  gm.). 

80  grains 
(5  gm.). 

2§  drachms 
(10  gm.). 

6|  drachms 
(25  gm.). 

12^  drachms 
(50  gm.). 

To  illustrate:  suppose  a  fluidounce  (30  c.c.)  of  a  2  per  cent,  solution 
of  cocaine  hydrochloride  is  wanted.  Opposite  the  desired  quantity  in 
the  first  column  find  the  quantity  expressed  in  the  2  per  cent,  column, 
which  in  this  case  is  10  grains  (0.60  gm.).  This  dissolved  in  the  fluid- 
ounce  of  water  will  make  the  desired  strength  of  solution. 


INCOMPATIBILITY. 

Unless  the  ingredients  of  a  prescription  are  compatible  with  each 
other  the  object  of  their  combination  may  be  lost,  for  a  reaction  may 
occur  between  two  drugs,  with  the  result  that  the  activity  of  each  is 
altered  or  destroyed.  Again,  such  reaction  may,  in  case  of  certain  sub- 
stances, produce  poisonous  compounds. 

Incompatibility  may  be  physical  or  chemical. 

Physical  Incompatibility  consists  of  (a)  alterations  in  conditions  of 
solubility  without  any  chemical  change,  and  also  (b)  pertains  to  the 
inability  of  certain  substances  to  mix  with  each  other,  as  oil  and  water. 

Examples  of  physical  incompatibility  are: 

1.  Gums  and  mucilaginous  substances  are  precipitated  from  aqueous 
solutions  by  alcohol  and  alcoholic  liquids — e.  g.,  syrup  of  acacia  with 
tincture  of  chloride  of  iron  will  precipitate  the  acacia. 

2.  Resinous  substances  are  precipitated  from  alcoholic  solutions  by 
water — e.  g.,  tincture  of  myrrh  with  water  will  become  turbid  from 
precipitation  of  resin. 


244  PRESCRIPTION    WRITING 

Chemical  Incompatibility  consists  in  chemical  reactions  between  sub- 
stances, whereby  their  nature  is  ahered.    There  may  be: 

1.  Simple  chemical  change  without  any  visible  result. 

2.  Simple  chemical  change  with  or  without  loss  of  medicinal  activity. 

3.  Precipitation  of  a  new  compound  that  is  insoluble. 

4.  Coagulation. 

5.  Formation  of  poisonous  compounds. 

6.  Formation  of  explosive  compounds. 

It  is  difficult  to  bring  all  instances  of  chemical  incompatibility  under 
rule;  and  the  knowledge  of  chemistry  necessary  to  predict  always  that 
incompatibility  will  occur,  is  not  a  common  possession.  The  attempt  is 
made  to  give  the  more  important  incompatibilities  in  connection  with 
the  individual  drugs  in  the  text  of  the  book.  Here,  however,  are  given 
some  general  statements  that  will  serve  as  a  basis  for  study.  These  may 
be  introduced  by  the  important  rule  that  drugs  should  never  he  prescribed 
with  their  chemical  tests. 

1.  AlkaUes,    hydrates    and   carbonates    react  with  acids    and    acid 

salts. 

2.  Alkalies,  hydrates  and  alkaline  carbonates  react  with  salts  of 
alkaloids.  If  the  latter  are  in  solution,  precipitation  of  the  pure  alkaloids 
occurs. 

3.  Solutions  of  tannic  acid  react  with  salts  of  copper,  iron,  lead  and 
mercury. 

4.  Solutions  of  tannic  acid  react  with  alkaloids  and  with  their  salts. 

5.  Acids  or  acid  salts  react  with  alkalies,  hydrates,  carbonates  and 
with  salts  of  glucosides. 

Other  common  incompatibilities  that  do  not  admit  of  classification 
include : 

The  reaction  of  certain  salts  with  each  other — e.  g.,  nitrate  of  silver 
with  any  chloride. 

Alcohol  and  chloral  hydrate. 

Antipyrine  and  spirit  of  nitrous  ether  (when  acid). 

Borax  and  solution  of  corrosive  sublimate. 

Carbolic  acid  (pure  or  saturated  aqueous  solution)  and  cocaine 
hydrochloride. 

Carbolic  acid  (pure  or  sat.  aq.  soln.)  and  antipyrine. 

Carbolic  acid  and  collodion. 

Glycerin  with  potassium  chlorate  and  tincture  of  chloride  of  iron. 

Iodine  (in  solution)  and  starch. 


PRESCRIPTION   WRITING  245 

Lime-water  and  calomel. 

Lime-water  and  corrosive  sublimate. 

Potassium  iodide  and  spirit  of  nitrous  ether  (if  acid). 

Potassium  permanganate  and  sulphur  (explode  when  triturated). 

Potassium  permanganate  and  glycerin,  syrup  or  other  liquids  con- 
taining organic  matter. 

Powerful  chemical  drugs  and  oxidizing  and  reducing  agents  should 
be  prescribed  alone. 

It  would  be  well  to  avoid  combining  the  following  with  other  sub- 
stances : 

Acids,  strong. 

Alkalies  and  their  hydrates. 

Arsenic. 

Creosote. 

Iron  salts. 

Mercuric  chloride. 

Potassium  chlorate. 

Potassium  permanganate. 

Silver  nitrate. 

Tannic  acid. 

It  should  be  noted  that  chemical  incompatibility  may  be  intentional, 
in  order  to  obtain  a  new  substance — e.  g.,  in  preparing  ferri  hydroxidum 
ammonia-water  (alkaline)  and  solution  of  ferric  sulphate  (acid)  are 
mixed,  the  result  being  a  precipitate  of  the  desired  substance. 

ANTAGONISM  OF  DRUGS. 

The  term  therapeutic  incompatibility  does  not  apply  to  the  combina- 
tion of  drugs,  but  to  their  action.  It  is  often  used  to  designate  what  is 
better  known  as  antagonism  of  drugs. 

We  recognize  and  employ  the  opposite  effects  of  drugs  to  the  extent 
of  combining  them  in  order  to  guard  against  poisoning,  and  of  admin- 
istering, in  case  of  poisoning,  a  drug  that  shall  counteract  or  antagonize 
the  toxic  action.  In  this  sense  we  speak  also  of  such  drug  as  a  physio- 
logic antidote  to  the  poison. 

While  we  thus  employ  antagonism  of  drugs  to  good  purposes,  in 
our  prescriptions  we  should  avoid  combinations  that  will  neutralize  the 
desired  effect  of  the  principal  drug  or  drugs. 

Antagonism  of  drugs  can  seldom  be  absolute— i.  e.,  there  are  very  few 
drugs  whose  effects  exactly  neutralize  the  effects  of  other  drugs.  In  the 
treatment  of  cocaine  poisoning  we  have  seen  that  two  drugs,  at  least, 


246 


PRESCRIPTION    WRITIXG 


are  needed  to  fully  cover  the  depressant  action  of  the  poison.  Antagon- 
ism, therefore,  is  usually  only  partial,  but  it  still  may  meet  the  most 
serious  symptom  in  a  case.  Thus  in  poisoning  by  morphine  the  most 
dangerous  condition  is  that  of  paralysis  of  the  respiratory  centre.  Strych- 
nine will  antagonize  this  condition,  though  it  has  almost  no  influence 
upon  the  narcosis. 

Among  the  medicines   discussed  in  this  treatise  the   most  positive 
antagonistic  relations  are  the  following: 

Drug. 


Aconite 


Atropine 


Bromides  \ 
Chloi-al     I 


Caffeine 


Chloroform 


Cocaine 


Digitalis 


Ether 


Morphine 


Kitrites 


Strychnine 


Antagonist. 

Site  of  antagonism. 

Atropine 
]S  itrites 

Vagus  nerve. 

Vagus  nerve. 

Caffeine 

Heart. 

,  Digitalis 

Heart. 

r  Aconite 
■<.   Digitalis 

Yagus  nerve. 

Vagus  nerve. 

(.  Morphine    . 

Kespiratory  centre,  cerebrum. 

f  Caffeine 

Brain,  circulation. 

1   Atropine 

Brain,  circulation. 

Digitalis 
Strychnine  . 

Heart. 

Medulla,  spinal  cord. 

r  Aconite 

Heart. 

]    Bromides,  chloral. 

Brain,  heart. 

Morphine    . 
.  Anesthetics . 

Brain,  respiratory  centre. 

Brain,  respiratory  centre,  heart. 

f  Caffeine 

Cerebrum,  respiratory  centre,  heart. 

1   Strychnine  . 

Heart,  respiratory  centre,  spinal  cord. 

L  Digitalis 

Heart,  vasomotor  system. 

f  Atropine 

Cerebrum,  respiratory  centre,  heart. 

1    Caffeine 
Strychnine  . 

Cerebrum,  respiratory  centre,  heart. 

Kespiratory  centre,  heart,  spinal  cord. 

^  Digitalis 

Heart. 

f  Aconite 

Heart. 

1   Atropine 

Vagus  nerve. 

J   Bromides,  chloral. 

Heart. 

1   Chloroform . 

Heart,  vasomotor  system. 

Cocaine 
[  iS itrites 

Heart. 

Vagus  centre,  vasomotor  system. 

/  Caffeine 

\  Strychnine  . 

Cerebrum,  respiratory  centre. 

Kespiratory  centre,  spinal  cord. 

f  Atropine 
-]    Caffeine 

Cerebrum,  respiratory  centre. 

Cerebrum,  respiratory  centre. 

(^  Strychnine  . 

Kespiratory  centre,  other  reflex  centres. 

'  Aconite 

Vagus  nerve. 

Atropine 

Vasomotor  system. 

Caffeine 

Vasomotor  system. 

Digitalis 

Vagus  centre,  vasomotor  system. 

Ergot. 

Vasomotor  system. 

Strychnine  . 

Vasomotor  system. 

'  Bromides,  chloral.  ^ledulla,  spinal  cord. 

Chloroform  .         .  Heart,  respiratory  centre,  spinal  cord. 

Ether.  .         .  Kespiratory  centre,  spinal  cord. 

Morphine    .         .  Kespiratory  centre,  other  reflex  centres. 

Nitrites        .         .  Vasomotor  system. 


PRESCRIPTION  WRITING  247 

Antagonism  of  local  remedies  depends  chiefly  upon  their  chemical 
qualities,  the  action  being  usually  an  antidotal  one,  as  when  an  acid  is 
neutralized  by  an  alkali,  or  silver  nitrate  by  sodium  chloride.  This  part 
of  the  subject  is  treated  whenever  necessary  in  connection  with  the 
various  local  remedies.  (For  chemical  antidotes,  see  Table  of  Poisons 
and  Antidotes.) 

DOSES. 

Posology,  or  the  science  of  dosage,  constitutes  an  important  part  of 
our  knowledge  of  drugs.  Whether  we  use  few  or  many  substances, 
safety  requires  us  to  know  concerning  each,  what  quantity  may  be 
expected  to  produce  a  certain  desired  effect  and  also  what  quantity  must 
not  be  exceeded  when  it  is  necessary  to  secure  its  full  physiologic  influence. 
Conditions  in  disease  vary  so  greatly,  and  the  individual  susceptibilities 
of  patients  are  so  uncertain,  that  we  must  regard  the  statement  of  a 
single  definite  quantity  for  a  dose  as  being  somewhat  arbitrary.  There- 
fore, it  is  advisable  to  know,  not  a  single  quantity,  but  a  range  which 
shall  include  the  minimum  and  the  maximum  of  ordinary  dosage.  Idio- 
syncrasy forbids  the  use  of  certain  drugs  with  certain  individuals.  It 
also  modifies  the  action  of  the  drug  in  some  cases.  Tolerance  for  certain 
drugs,  particularly  morphine,  may  be  established,  so  that  those  who  take 
it  habitually  frequently  come  to  use  doses  many  times  greater  than  the 
ordinary  poisonous  dose.  The  mode  of  administration,  whether  by 
stomach  or  hypodermically,  will  modify  dosage.  (See  chapter  on  Admin- 
istration of  Medicines.)  After  all,  the  dose  of  a  drug  is  a  relative  rather 
than  a  positive  quantity,  which  requires  to  be  varied,  according  to  con- 
ditions, within  a  certain  range  of  efficiency  and  safety.  The  doses  of 
the  principal  drugs,  or  of  one  or  two  preparations  of  each,  which  repre- 
sent them  fully,  should  be  learned.  Of  the  occasional  and  unimportant 
drug,  the  dose  will  be  learned  only  to  be  forgotten,  and  will  require  to 
be  learned  anew  when  it  chances  to  be  needed. 

Dosage  for  Children.  The  doses  usually  given  in  text-books  and  tables 
are  for  adults.  For  children  only  a  fractional  quantity,  proportional  to 
the  age,  may  be  used.  The  simplest  rule  for  the  calculation  of  a  child's 
dose  is  that  known  as  Cowling's  Rule,  which  is :  Divide  the  age  of  the 
child  at  its  next  birthday  by  24.  Thus,  a  child  three  years  old  will  have 
2^  or  I  of  the  adult  dose.  In  connection  with  such  calculation  it  must 
be  borne  in  mind  that  children  are  very  susceptible  to  the  action  of 
opium  and  morphine;  therefore,  these  drugs,  always  to  be  avoided  with 


248  PRESCRIPTIOX  WRITIXG 

children  if  possible,  may  only  be  given  iu  rather  smaller  quantity  than 
the  proportional  dose  by  rule. 

THE  PRESCRIPTION. 

A  proper  prescription  always  consists  of  five  parts : 

1.  The  heading. 

2.  Names  and  quantities  of  ingredients. 

3.  Directions  to  the  compounder. 

4.  Directions  to  the  patient. 

5.  Date  and  signature. 

These  will  be  considered  in  order: 

1.  The  Heading.  Anciently  the  prescription  was  begun  with  a  prayer 
to  Jupiter  or  other  heathen  deity.  I^ater  this  was  shortened  to  the  simple 
sign  of  Jupiter  (%).  "With  an  upright  stroke  before  it  we  have  a  resem- 
blance to  the  sign  I^,  which  we  use  to-day.  To  us  this  sign  really  means : 
"Take,"  being  an  abbre^^ation  of  the  imperative  form  recipe  of  the 
Latin  verb  recipio — to  take. 

2.  Names  and  Quantities  of  Ingredients.  Tlie  names  are  usually 
written  in  Latin,  for  the  reasons  that  this  is  not  subject  to  the  changes 
of  a  modern  language  and,  being  a  universal  language  of  science,  it  is 
known  the  world  over.  A  formula  in  Latin,  therefore,  can  be  read 
anwhere  in  the  world  of  science  to-day,  and  doubtless  will  be  just  as 
current  one  hundred  years  hence  as  now. 

The  quantities  are  expressed  either  in  the  terms  of  apothecaries' 
weight  and  corresponding  liquid  measure,  or  in  terms  of  the  metric 
system.  The  latter  has  the  advantage  of  simplicity,  in  being  a  decimal 
system.  Calculation  by  it  is  easier,  and  there  is  less  danger  of  error, 
because  the  position  of  a  figure  denotes  its  value,  and  not  an  added  sign 
that  may  be  poorly  written. 

3.  Directions  to  the  Compounder.  In  most  cases  the  precise  mode  or 
detail  of  compounding  is  better  left  to  the  dispenser,  who  is  trained  in 
that  art,  and  the  simple  abbreviation  M.,  which  stands  for  the  Latin 
imperative  misce,  meaning  "mix,"  is  sufficient.  Only  when  the  pre- 
scriber  has  special  directions  to  give,  and  in  directing  the  number  of 
pills  or  powders  into  which  a  mixture  is  to  be  divided,  need  he  write  out 
his  directions  in  full.  In  such  case  Latin  may  be  used,  but  plain  English 
is  preferable,  unless  the  prescription  is  likely  to  go  to  a  foreign  country. 

4.  Directions  to  the  Patient.  This  part  added  to  a  formula  makes  of 
it  a  prescription.  It  is  begun  with  the  abbreviation  Sig.  (or  S.),  which 
stands  for  the  Latin  signa,  meaning  "Write;"  and  whatever  is  directed 


Prescription  Writing  249 

should  follow  this  sign  and  be  written  without  abbreviation,  so  that 
it  may  be  copied  verbatim  upon  the  label.  Not  only  should  these  direc- 
tions be  written  out  in  full,  but  they  should  be  read  to  the  patient  or 
attendant,  in  order  to  guard  against  danger  through  a  possible  error 
in  copying.  The  directions  to  the  patient  must  state  how  the  medicine 
is  to  be  used — if  locally,  the  word  "apply"  may  be  included;  there  is  good 
reason  also  for  placing  immediately  after  the  *Sig.  '  the  term  "mouth- 
wash," "gargle,"  "ointment,"  "wash,"  or  whatever  will  best  designate 
the  nature  of  the  local  application  and  serve  to  guard  against  its  being 
taken  internally;  if  internally,  the  directions  must  include  dose  in  drops, 
teaspoonfuls,  etc.,  and  the  time  or  intervals  of  taking.  This  part  of  the 
prescription  must  be  very  explicit,  and  the  common  phrase  "use  as 
directed,"  with  only  verbal  directions  to  the  patient,  should  be  discarded. 

In  case  a  poisonous  application  is  ordered  it  is  well  to  add  the  word 
"Poison"  to  the  directions,  with,  however,  verbal  explanation  to  the 
patient  or  attendant  as  to  its  proper  use. 

5.  Date  and  Signature.  The  date  is  essential  for  reference,  and  the 
prescriber's  signature  for  authenticity.  It  is  common  practice,  however, 
to  use  printed  forms  which  have  the  prescriber's  name  and  address 
above  or  below  the  blank  space  reserved  for  the  prescription  proper, 
in  which  case  the  signature  is  often  omitted. 

The  name  or  initials  of  the  patient  should  be  added,  in  order  to  avoid 
the  use  of  the  wrong  medicine,  in  case  of  more  than  one  prescription 
being  filled  at  the  same  time  for  different  members  of  a  family. 

Sometimes  a  special  note  in  addition  to  all  the  above  will  be  advisable, 
as  when  quite  large  doses  of  a  drug  are  ordered;  the  statement  "large 
dose  intended,"  or  writing  out  the  quantity,  will  show  the  dispenser 
that  the  amount  ordered  is  correct. 

Again,  the  evil  of  repeating  prescriptions  by  unprofessional  phar- 
macists may  be  guarded  against  by  writing  prominently  upon  the 
prescription  the  words  "not  to  be  repeated." 

The  reference  above  to  improper  pharmacy  leads  the  author  to  express 
his  appreciation  of  the  professional  pharmacy  which  is  so  evident  to-day. 
The  knowledge  of  doses  that  the  pharmacist  is  required  to  possess  is  a 
safeguard  against  errors  of  dosage  in  prescriptions.  The  prescriber  is 
responsible  for  whatever  he  writes,  but  physicians  have  often  been  saved 
the  humiliation  of  discovered  error  in  prescribing,  or  the  results  that 
might  follow,  by  the  co-operation  of  the  pharmacist  in  calling  attention 
confidentially  to  the  same — a  kind  of  favor  too  often  unappreciated 
by  the  prescriber. 


250 


PRESCRIPTION   WRITING 


THE  USE  OF  LATIN  IN  PRESCRIPTIONS. 

To  write  prescriptions  in  best  form  requires  some  knowledge  of  Latin, 
especially  of  the  declensions  of  nouns  and  adjectives,  but  not  more  than 
can  be  acquired  in  a  very  short  time  with  the  aid  of  a  Latin  grammar. 
To  one  not  sufficiently  familiar  with  the  language,  this  course  is  earnestly 
advised,  as  repaying  well  the  effort  that  is  necessary.*  As  a  means  of 
review,  and  in  order  to  emphasize  what  is  really  essential  to  our  purpose, 
a  brief  outline  of  the  essential  grammatic  forms  is  here  given,  without 
any  attempt  at  completeness.  Many  case-endings  are  never  used  in 
prescriptions,  and  are,  therefore,  omitted.  The  genitive  endings  are 
given  prominence  because  they  are  almost  invariably  employed. 

Declensions  of  Nouns  and  Adjectives. 


1st  Declension. 

2d  Declension. 

3d  Declension. 

4th  Declension. 

Koims. 

Fern. 

Masc.            Neut. 

Masc.         -.T     . 
and  Fem.      ^®'^''- 

Masc.         -VT     . 
and  Fem.      ^^'^'^• 

Singular  : 

Nominative 

a  (e)              i  us  (os)       um  (on) 

(various) 

us                         u 

Genitive 

ae  (es) 

1 

is 

us                           u 

Accusative 
Ablative 

Plural : 

Nominative 

am  (en) 

a  (e) 

ae 

um  (on) 
o 

i                           a 

em          (as  Xom.) 
e 

es                          a 

The  4th  declension 
includes  only  four 
names  of  drugs : 
Cornus 
Fructus 
Quercus 
Spiritus 

Genitive 

arum 

Oram 

nm  (ium) 

Accusative 

as 

OS                       a 

es                         a 

Exceptions : 

i 
Theobroma — tis,        Rhus— ois,  is  of 
and  Physostigma  ,  the  3d  declension. 
—tis.  are  of  the  3d 
declension. 

Indeclinable : 

Amyl                        Gambir                     Alcohol       )  are  regarded  by 
Buchu                       Kino                          Eucalyptol    v     some  authorities 
Catechu                   Sassafras                  Menthol       )     as  indeclinable. 
Elixir 

Adjectives. 

1st  and  2d  Declension. 
Fern.       Masc.       Neut. 

3d  Delension. 
and  Fem.                •^^'^^• 

Singular : 

Nominative 

Genitive 

Accusative 

a           us  (er)        um 
ae              i                i 
am          um           um 

is  (s)                    e  (s) 

is 
em                      e  (s) 

Adjectives  of  other  ter- 
minations and  plural 
forms  are  very  seldom 
used  in  prescriptions. 

*  A  very  useful  aid  is  the  Latin  Grammar  of  Pharmacy  and  Medicine,  Robinson. 
P.  Blakiston's  Son   &  Co.,  Philadelphia. 


PRESCRIPTION  WRITING  251 

The  rules  of  Latin  grammar  apply  as  to  relation  of  nouns,  adjectives, 
verbs  and  other  parts  of  speech. 

Use  of  Cases.  The  nominative  case  is  never  used  in  a  prescription, 
as  the  sentence  is  always  introduced  by  the  imperative  recipe,  the  sub- 
ject of  which  is  thou  understood.    The  complete  sentence  would  be: 

Take  thou  I  of  a  substance  I    a  quantity. 
I       (genitive)       I  (accusative) 

The  genitive  case  of  the  name  of  ingredient  is  required  when  the 
quantity  is  expressed  by  a  noun,  as: 

Take  thou  I  of  a  substance  I     one  ounce. 
I       (genitive)       I  (accusative) 

The  accusative  case  of  the  name  of  the  ingredient  is  required  when 
the  quantity  is  expressed  by  a  simple  numeral  adjective,  as: 
Take  thou  Jour  pills  =  R .  Pilulas  iv. 
The  ablative  case  is  used  after  the  preposition  cum  (meamng  with) ,  as: 

R. — Ferri  hydroxidi  cum  magnesii  oxido,  gj. 
Verbs.     The  few  verbs  employed  are  in  the  imperative  form  except 
where  the  directions  to  the  compounder  are  written  in  Latin,  when  the 
passive  form  may  be  also  needed,  as: 

R. — Massse  hydrargyri,  gr.  xxx. 

Fiant  pilulae,  vj.     {Let  be  made  pills  six.) 

WEIGHTS  AND  MEASURES. 

The  system  of  weights  and  measures  most  approved  in  scientific 
circles  is  the  metric  system.  This  should  be  mastered  by  every  student 
in  scientific  fields  to-day.  It  is  not  possible  to  discard  the  apothecaries' 
system  entirely  at  the  present  time,  because  of  the  large  number  of 
practitioners  who  have  used  it  for  years;  but  no  student  in  any  depart- 
ment of  medical  science  should  be  excused  from  acquiring  a  practical 
familiarity  with  the  metric  system.  The  United  States  Pharmacopceia 
employs  it  exclusively  in  the  expression  of  quantities  of  ingredients. 

\Mierever  the  old  system  is  employed  its  denominations  may  be 
reduced  to  three,  as  below: 

Apothecaries'.  Liquids. 

60  grains  (gr.)  =  1  drachm  (5)  60  minims  (rr\^)  =  1  fluidrachm  (f3) 

8  drachms  =  1  ounce  (5)  8  fluidrachms  =  1  fluidounce  (f5) 

The  use  of  the  scruple  9  (20  gr.)  often  leads  to  a  confusion  of  signs,  and  the 
pound  (16  oz.)  is  seldom  required  in  prescribing. 


252 


Prescription  writing 


The  Metric  System.  Among  the  advantages  of  the  metric  system  the 
one  most  prominent  is  that  of  being  a  decimal  system.  It  corresponds 
in  this  respect  with  our  American  system  of  money.  The  latter  can, 
therefore,  iUustrate  the  former  in  a  very  simple  way,  as  appears  below, 
the  decimal  point  or  a  perpendicular  line  being  the  dividing  point 
between  units  and  fractions : 


United  States  money     10 


Grams 

Metric  weights  10 


Equivalents  in  1 

apothecaries'  weight 


Cu.  centimeters 

Equivalents  in  1 

liquid  measure 


a  = 
0   0 


g     03 
bo   50 


0    0 


Note.— In  practical  use  we 
disregard  the  term  decigram, 
much  as  we  do  the  term  dime, 
.  using  centigrams,  as  we  do  cents, 
"  for  any  fraction  of  the  unit ;  but 
the  term  milligram  is  much  used 
because  of  the  small  fractions 
which  so  many  doses  require. 


1 

0   1 
0   0    1 


1 

0   1 
0   0   1 


15.4  grains. 
1.5       " 
0.15     " 
0.015  " 


Approximately. 
15  grains. 

IV2     " 
1/6     " 

1/60      " 


Approximately. 
16.23  minims.    16  minims. 
1.6         "  11/2     " 

0.16       "  1/5     " 

0.016      "  i/sn    " 


The  units  of  the  metric  system  are : 

Unit  of  length:  Meter  =  One  forty-millionth  part  of  the  earth's 
meridian  (39.37  inches). 

Unit  of  capacity:     Liter  =  One  cubic  decimeter  (1.05  quarts). 

Unit  of  weight :  Gram  =  Weight  of  one  cubic  centimeter  of  distilled 
water  at  4°  C.  (15.4  grains). 

Equivalents  of  apothecaries'  weights  and  liquid  measures  in  the 
metric  terms  are: 


Metric  A  bhreviations. 
Gm.  or  c.c.  dg.  eg.  mg. 


1  grain  =  approximately 
1  drachm  =  approximately 
1  ounce  =  approximately 


4 
31 


1  minim  =  approximately  06 

1  fluidrachm  ■=  approximately  3    7 

1  fluidounce  =  approximately  30 

1  pint  =  approximately  475* 

1  quart  =  approximately  950 

*  For  ordinary  purposes  500  c.c.  is  the  convenient  approximate  equivalent  of  a  pint 
and  1000  c.c.  of  a  quart. 


065 


PRESCRIPTION  WRITING  253 

The  gravi  is  a  measure  of  weight  and  the  cubic  centimeter  of  capacity, 
but  Uquids  may  be  weighed  and  expressed  in  grams  or  decimals  of  a 
gram.  The  United  States  Pharmaco'poeia  weighs  sohds  and  measures 
liquids.  In  prescriptions,  fractional  quantities  are  expressed  in  decimals 
of  the  gram,  whether  they  are  liquid  or  solid. 

Equivalents  of  common  measures  (approximate)  are: 

A  drop  =  0.03-0.06  gm.  (three  to  six  centigrams). 

A  teaspoonful  =  4-5  c.c.  (four  to  five  cubic  centimeters). 

A  dessertspoonful  =  8-10  c.c.  (eight  to  ten  cubic  centimeters). 

A  tablespoonful  =  15  c.c.  (fifteen  cubic  centimeters). 

A  heaped  tablespoonful  =  20  c.c.  (twenty  cubic  centimeters). 

Rules  for  Converting  Quantities  to  Metric  Terms: 

1.  If  in  grains  (or  minims),  multiply  the  number  by  0.065  (fiuids  0.06) 
or  divide  by  15  (fluids  16).  The  result  will  express  the  quantity  in 
grams  or  decimal  of  a  gram. 

2.  If  in  drachms,  multiply  the  number  by  4  (fiuids  3.70).  The 
product  will  express  the  quantity  in  grams. 

3.  If  in  ounces,  multiply  the  number  by  31  (fiuids  30).  The  product 
will  express  the  quantity  in  grams. 

Rules  for  Converting  Quantities  from  Metric  Terms: 

1.  Divide  grams  by  0.065  (fiuids  0.06)  or  multiply  by  15  (fiuids  16). 
The  result  will  be  in  grains  (or  minims). 

2.  Divide  grams  by  4  (fiuids  3.70).    The  result  will  be  in  drachms. 

3.  Divide  grams  by  31  (fiuids  30).    The  result  will  be  in  ounces. 

In  learning  doses  in  metric  terms,  it  is  well  to  begin  with  convenient 
quantities  that  approximate  the  usual  dose;  thus: 

For  substances  with  a  minimum  dose  of  -^-^  of  a  grain,  adopt  0.001  gm. 
(1  milligram)  as  the  convenient  basis. 

For  substances  with  a  minimum  dose  of  1  grain,  adopt  0.05  gm.  (5 
centigrams)  as  the  starting  point. 

For  substances  having  the  minimum  dose  of  10  grains,  adopt  50  gm. 
(50  centigrams)  as  the  starting  point. 

For  larger  doses  adopt  grams  and  half-grams  as  nearly  as  possible. 

Rules  for  Use  of  the  Metric  System  in  Prescribing: 
The  difficulty  of  applying  the  metric  system  to  prescription  writing 
by  those  accustomed  to  think  in  the  old  system^  is  very  largely  removed 


254     '  -PRESCRIPTION   WRITING 

by  following  the  rule  given  below.  This  does  away  entirely  with  the 
need  of  calculating  total  quantities,  and  renders  prescribing  much  easier 
than  with  the  old  system. 

As  there  are  between  fifteen  and  sixteen  grains  in  a  gram,  the  ordering 
of  fifteen  or  sixteen  doses  always  establishes  a  relation  between  the  two 
systems,  which  permits  us  to  apply  the  following  rule.* 

1.  Make  the  whole  quantity  to  consist  of  sixteen  doses;  then — 

2.  The  number  that  represents  the  single  dose  of  an  ingredient  in 
grains  or  minims  will  express  the  required  quantity  of  that  ingredient 
in  grams  or  cubic  centimeters. 

For  example: 

Gm.  or  c.c. 

B . — Potassii  bromidi  (single  dose  10  grains),  10 

Morpliinee  sulphatis  (single  dose  \  grain),  25 

Spiritus  setheris  nitrosi  (single  dose  30  minims),  30 

Aquse,  c|.  s.  ad  (16  teaspoonful  doses),    '  60 

M.— Sig.,  etc. 

The  same  rule  applies  in  prescribing  poM^ders  or  pills : 

Gm.  or  c.c. 

B . — Pulveris  ipecacuanhae  et  opii  (single  dose  5  grains),  5 

Pulveris  digitalis  (single  dose  1  grain),  1 

Strychninfe  sulphatis  (single  dose  Jq  grain),  02 

Misce  et  divide  in  chartulas  numero  xvi. 

The  convenience  of  the  decimal  system  in  ordering  and  preparing 
percentage  solutions  is  apparent.  With  a  total  quantity  of  1000,  100,  or 
10  c.c.  the  calculation  of  quantity  of  ingredients  is  very  simple. 


CONSTRUCTION  OF  PRESCRIPTIONS. 

Dentifrices.  If  we  desire  to  write  a  prescription  for  a  tooth  powder, 
we  consider  first  the  essential  qualities  of  the  ingredients  which  should 
enter  into  it.    Ordinarily  we  want  a  tooth  powder  to  be: 

1.  Antacid. 

2.  Slightly  abrasive  (just  sufficient  to  prevent  accumulation  of 
deposits). 

3.  Aseptic  or  antiseptic. 

4.  Pleasant  to  the  taste. 

*  Long.    Medical  News,  Philadelphia,  March  25,  1893. 


PRESCRIPTION  WRITING.  255 

Occasionally  also  we  desire  it  to  be 
Astringent  or 
Stimulating, 
but  these  two  qualities  are  needed  in  pathologic  rather  than  normal 
conditions.     The  formula  need  not  be  complicated.     Prepared  chalk 
and  powdered  soap  will  really  cover  all  essentials,  except  that  taste 
may  be  further  consulted  as  to  flavoring. 

Written  out  in  simple  English,  we  may  have  a  combination  something 
like  this,  using  our  own  preference  for  either  the  apothecaries'  or  the 
metric  weights: 

1.  Take 

f  of  prepared  chalk,              ten  ounces,  or  310  grams. 

2.  J  of  powdered  soap,               two  ounces,  or  62  grams. 
I  of  oil  of  wintergreen,          five  minims,  or  0.30  grams. 

3.  Mix  and  triturate  thoroughly. 

4.  Write:    Use  with  toothbrush  each  evening. 

5.  For  A.  B.,  Oct.  10,  1902.  (Chas.  Dale). 

But  custom  and  certain  advantages  lead  us  to  prefer  the  use  of  Latin 
terms  and  other  characters  as  follows: 

Gm. 
R. — Cretse  prseparatae,  $x        or       310 

Saponis  pulv.,  Sij        or         62 

Olei  gaultherise,  Tt\^v        or  30 

M. — ^Triturate  thoroughly. 
Sig. — Use  with  toothbrush  each  evening. 
For  A.  B.,  Oct.,  1902.  (Chas.  Dale.) 

This  formula  is  simply  suggestive  and  admits  of  any  desired  modi- 
fication or  addition.  Other  ingredients  and  other  proportions  of  these 
ingredients  will  be  employed  at  pleasure.  If  we  analyze  the  qualities 
of  such  a  combination  we  find  the  value  of  each  ingredient  to  be  distinct, 
as  here  indicated: 

Greta  prseparata  is  antacid  and  slightly  abrasive. 
Sapo  is  alkaline,  detergent  and  antiseptic. 
Oleum  gaultherise  is  a  flavoring  agent. 

It  will  be  noticed  that  the  Latin  names  of  ingredients,  and  their 
adjectives,  are  given  in  the  genitive  case.  The  reason  for  this  appears 
in  the  English  version  of  the  formula,  the  reading  being:  Take  ten 
ounces  of  prepared  chalk,  etc. 

The  antacids  that  serve  the  same  purpose  as  prepared  chalk,  but 
which  are  less  abrasive,  are  magnesium  oxide,  magnesium  carbonate, 
sodium  bicarbonate  and  borax,  the  last-named  being  also  antiseptic. 


256  PRESCRIPTION   WRITING 

Powdered  pumice  and  charcoal  are  too  gritty  and  harsh  for  continued 
use.  They  may  injure  both  the  gums  and  the  enamel,  and  they  are, 
therefore,  to  be  discarded  from  our  formulas. 

Powdered  orris  root  (Radix  Iridis  Florentinse)  is  valued  by  many, 
because  of  its  reputed  tonic  influence  upon  the  mucous  membrane,  but 
it  is  not  an  antacid. 

The  antiseptics,  other  than  soap,  that  may  be  employed,  are  borax, 
resorcin,  naphtol  and  boric  acid.  The  last  named  may  be  combined 
with  sufficient  antacid  to  leave  the  reaction  of  the  mouth  alkaline  or 
neutral. 

The  flavoring  agents  include  any  of  the  pleasant  volatile  oils,  or 
powdered  drugs  containing  them — e.  g.,  powdered  cinnamon.  Some 
of  the  volatile  oils  are  costly,  and,  therefore,  not  commonly  used.  Oil 
of  rose  is  the  most  expensive.  These  oils  are  not  included  for  any 
medicinal  effect,  but  only  as  flavoring  agents;  therefore  they  are  used 
in  very  small  quantity. 

Coloring  agents,  such  as  carmine  or  an  aniline  color,  may  be  added 
if  desired,  but  metallic  pigments  had  better  be  avoided,  for  fear  of 
staining  exposed  dentine. 

If  the  dentifrice  is  preferred  in  form  of  a  paste,  sufficient  glycerin 
may  be  added,  but  syrup  or  honey  are  to  be  avoided  on  account  of  being 
readily  fermentable.  For  the  same  reason  sugar  is  inferior  as  a  sweeten- 
ing agent.  Saccharine  may  be  used,  as  it  does  not  ferment,  and,  being 
280  times  sweeter  than  cane-sugar,  only  a  small  quantity  is  needed. 

Anyone  desiring  his  own  special  formula  for  a  dentifrice  can  easily 
attain  his  object  through  a  little  experimentation  with  the  substances 
here  suggested,  and  the  effort  will  be  profitably  expended.  The  thought 
should  be  prominent,  however,  that  strong  antiseptics  are  not  constantly 
needed  in  normal  conditions;  and  the  more  thoroughly  the  mouth  and 
teeth  are  habitually  cleansed  the  less  will  they  be  required. 

Mouth  Washes.  Washes  for  the  mouth  and  teeth  may  be  needed  for 
the  following  purposes: 

1.  To  neutralize  acid  fluids,  whether  introduced  or  present  as  abnormal 
secretion. 

2.  To  cleanse  the  mouth. 

3.  To  disinfect  when  ferments  or  septic  bacteria  are  active. 

4.  To  prevent,  as  an  antiseptic,  the  growth  of  ferments  and  septic 
bacteria. 

5.  To  exert  an  astringent  action  upon  the  mucous  membrane. 

6.  To  stimulate  nutrition  of  the  mucous  membrane. 


PRESCRIPTION   WRITING  257 

Many  agents  are  employed  to  accomplish  these  purposes,  and  the 
possible  combinations  are  without  number.  But  it  may  be  stated  as  a 
cardinal  rule,  that  mouth  washes  should  possess  antacid  and  antiseptic 
properties.  It  is  impossible  even  in  health  to  maintain  a  strictly  aseptic 
condition  of  the  mouth,  while  in  disease,  local  or  general,  efforts  are  still 
less  availing.  It  is  often  essential,  therefore,  that  a  positive  aid  in  the 
nature  of  an  antiseptic  should  be  freely  employed,  always,  how^ever, 
with  due  appreciation  of  the  harm  that  may  follow  the  improper  use 
of  the  stronger  agents. 

Some  agents  addressed  to  a  single  purpose  (as  a  detergent  or  an 
astringent)  may  be  used  alone  in  aqueous  solution.  Alcohol  is  not  a 
suitable  vehicle  in  mouth-washes  unless  its  astringent  action  is  desired, 
but  its  aid  as  a  solvent  may  be  necessary.     It  must  always  be  diluted. 

The  two  main  points  to  consider  in  prescribing  a  mouth  wash  are 
efficiency,  and  safety  to  the  soft  tissues. 

Certain  agents,  including  creosote,  borax  and  boric  acid,  are  regarded 
as  quite  efficient  in  a  saturated  aqueous  solution  and  may  be  used  freely 
without  harming  the  tissues;  but  carbolic  acid,  corrosive  sublimate, 
chloride  of  zinc  and  formaldehyde  would  be  very  irritating  in  saturated 
solution.    They  must  be  very  largely  diluted  for  use  in  mouth  washes. 

One  of  the  most  efficient  agents  is  carbolic  acid,  but  it  should  not  be 
used  stronger  than  1  per  cent.;  and,  though  it  is  only  very  slightly  acid 
in  reaction,  it  is  well  to  use  an  alkali  with  it  as  follows: 


Gm.  or  c.c 

R  • — Acidi  carbolici,  2 

Sodii  bicarbonatis,  15 

Glycerini,  30 

Aquse,  q.  s.  ad     200 


(gr.  xxx) 

(Sj) 
(f5vij)-M. 


Sig. — Use  as  mouth  wash  every  three  hours. 

Another  efficient  similar  combination  is  Dobell's  solution.  (See 
formula,  p.  123.) 

The  excellent  work  of  Dr.  W.  D.  Miller  has  shown  benzoic  acid  and 
salicylic  acid  to  be  among  our  most  efficient  mouth  antiseptics  when 
used  in  1  per  cent,  solution;  but  they  are  only  slightly  soluble  in  water, 
requiring  281  and  308  parts  respectively,  and  they  are  acid  in  reaction. 
It  is  found,  however,  that  with  the  aid  of  borax  a  1  per  cent,  alkaline 
solution  of  either  of  these  may  be  prepared ;  although  it  is  probable  that 
their  antiseptic  power  is  less  in  an  alkaline  solution.  A  saturated 
aqueous  solution  of  borax,  with  1  per  cent,  of  either  salicylic  or  benzoic 
^cid  added,  is  presented  in  the  following: 

17 


258  PRESCRIPTION    WRITING 

Gm.  or  c.c. 

R . — Sodii  boratis,  5  (3iss) 

Acidi  salicylici,  '  1  (gr.  xa') 

Aqufe,        "  100  (fsiij)-^. 

Dissolve  the  borax  in  the  water,  then  add  the  saUcyhc  acid. 

Sig. — Mouth  wash. 

Gm.  or  c.c. 

R. — Sodii  boratis,  5  (3iss) 

Acidi  benzoici,  1  (gr.  xv) 

Aqu«,  100  (fsiij)— M. 

Dissolve  the  borax  in  the  water,  then  add  the  benzoic  acid. 

Sig. — ^Nlouth  wash. 

Flavoring  agents  may  be  used  in  the  above  at  pleasure,  in  the  form  of 
medicated  waters,  such  as  aqua  cinnamomi,  or  a  little  volatile  oil. 
Creosote  may  be  ordered  in  its  official  preparation : 

c.c. 

R. — Aquae  creosoti,  100 

Sig. — [Nlouth  wash.    Use  after  each  meal  and  at  bedtime. 

Hydrogen  peroxide  is  entirely  safe  to  use  in  the  official  3  per  cent, 
sokition,  but  it  Is  acid  in  reaction.    It  is  useful  in  septic  conditions. 

ORDER  OF   WRITING  A  PRESCRIPTION. 

In  ordering  a  combination  for  local  use  the  strength  of  solution  is  the 
important  consideration,  while  in  a  prescription  for  internal  effect  the 
dose  is  most  important.  In  either  case  the  order  to  be  followed  in 
writing  is  this: 

1.  ^Yrite  heading  and  names  and  quantities  of  all  ingredients  thus: 

R . — Potassii  bromidi, 

Spiritus  Eetheris  nitrosi, 

AquEe, 

S\Tupi  lactucaiii. 

2.  Decide  upon  the  size  of  the  combination  and  the  number  of  doses. 
The  example  may  be  for  a  feverish  child;  the  dose  a  teaspoonful,  and  the 
total  mixture  2  fluidounces  or  60  c.c.     This  would  give  us  16  doses. 

3.  Multiply  the  single  dose  of  each  ingredient  by  the  number  of  doses, 
thus: 

Of  potassium  bromide  we  will  give  a  single  dose  of  6  grains,  6  X  16 
doses  =  96  grains  or  about  IJ  drachms.  Of  spirit  of  nitrous  ether  the 
single  dose  of   15  minims  X  16  =  240  minims  or   4  fluidrachms.      Of 


PRESCRIPTION   WRITING 


259 


water  we  will  use  enough  to  ensure  ready  solution,  say  6  fluidrachms ; 
and  syrup  of  lactucarium  will  make  up  the  balance — quantum  sufficit 
(q.  s.)  ad  (up  to)  foij.     The  result  will  be: 


I^. — Potassii  bromidi, 

Spiritus  setheris  nitrosi, 

Aquse, 

Syrupi  lactucarii, 


Gm.  ore.c 

oiss     or        6 

fSiv      "       15 

fSvj      "       24 

q.  s.  ad     foij       "       60 


Or  we  may  apply  the  simple  rule  previously  given  for  the  use  of  the 
metric  system  (p.  254). 

4.  Add  the  3d,  4th,  and  5th  parts  of  the  prescription. 

Whenever  we  order  the  same  quantity  of  each  of  two  ingredients, 
we  may  use  the  abbreviation  aa,  meanimg  of  each: 


'Bj.. — Sodii  bicarbonatis, 
Sodii  salicylatis, 


aa  3j 


A  little  practice,  as  a  matter  of  course,  is  necessary  to  easy  prescription 
writing.  The  author  feels  that  the  foregoing  will  efficiently  aid  the 
ambitious  student  in  this  direction. 

ABBREVIATED  TERMS  IN  COMMON  USE  IN  PRESCRIPTIONS. 


ad  . 

ad  lib.    ad  libitum 

aa.     ana 

b.  i.  d.     bis  in  dies 

Br.  P.      . 

c.c. 

cum 

fiat,  fiant 

gm. 

gr.  ... 

gtt. 

nt  .        .         .         . 

M.     misce 

N.F.       . 

p.  r.  n.    pro  re  nata 

q.  s.    quantum  sufficit 

R.    recipe 

ss.    semissis 

S.  Sig.    signa 

sine 

t.  i.  d.    ter  in  die 

U.  S.  P.  .        , 


to,  up  to. 

at  pleasure. 

of  each. 

twice  daily. 

British  Pharmacopoeia. 

cubic  centimeter. 

with. 

let  (it)  (them)  be  made. 

gram. 

grain. 

drop  or  drops. 

minim. 

mix. 

National  Formulary. 

as  occasion  arises. 

as  much  as  necessary. 

take. 

a  half. 

write. 

without. 

three  times  a  day. 

United  States  Pharmacopoeia 


CHAPTER   XXI. 
POISONS. 

A  POISON  may  be  defined  to  be  a  substance  which,  when  introduced 
into  the  body,  causes  disease  or  death.  But,  in  accepting  this  definition, 
foreign  bodies  or  agents  that  act  mechanically  must  be  excluded,  as,  for 
example,  a  bullet.  Certain  substances  also  that  produce  disease  in  the 
system  are  not  usually  classed  among  poisons.    Of  these  there  are: 

Venom,  the  natural  protective  secretion  of  certain  reptiles  and  insects. 

Virus,  a  rather  indefinite  term  that  has  been  applied  to  the  microbic 
cause  of  an  infectious  disease  or  to  the  characteristic  poison  developed 
in  course  of  the  disease. 

With  the  recognition  of  the  definite  organisms  that  cause  the  several 
infectious  diseases  the  term  virus  has  fallen  somewhat  into  disuse.  In 
its  place  we  have  the  more  definite  terms  of  bacterium,  as  the  cause,  and 
toxin,  a  poisonous  product  of  the  growth  of  the  bacterium. 

[Antitoxin  is  a  substance  formed  in  the  body  as  a  reactionary  protection 
against  the  action  of  a  toxin  of  a  disease  The  presence  of  a  toxin  is 
necessary  to  stimulate  the  formation  of  the  antitoxin  which  is  capable 
of  neutralizing  it.  The  most  familiar  example  of  an  antitoxin  is  that 
of  diphtheria,  which  is  prepared  in  the  blood  of  the  horse  and  used  to 
neutralize  the  toxin  of  the  disease  in  the  human  being.] 

Ptomains  are  basic  organic  compounds  formed  by  the  action  of  bacteria 
upon  nitrogenous  matter.  Some  are  poisonous,  and  some  resemble 
vegetable  alkaloids  in  their  action. 

Leukomains  are  basic  substances  that  result  from  tissue  metabolism. 
Some  of  these  are  poisonous. 

The  usual  use  of  the  term  poison  refers  to  drugs  that,  when  taken  in 
overdose  or  in  concentrated  form,  produce  disease  or  death. 

The  law  recognizes  the  responsibility  that  attaches  to  the  sale  of 
poisons,  and  requires,  in  most  communities,  that  all  poisons,  except 
those  dispensed  upon  a  physician's  prescription,  shall  be  distinctly 
labelled  and,  in  case  of  the  more  powerful  substances,  that  a  record 
shall  be  made  of  the  sale. 

The  substances  included  in  the  list  of  poisons  vary  very  greatly  in 
their  action,  as  to  time  required  for  their  poisonous  effects,  part  of  the 
(260) 


POISONS  261 

system  attacked,  and  character  of  symptoms  produced.  Thus  arsenic, 
one  of  the  most  destructive  poisons,  acts  slowly,  while  carbolic  acid  may 
cause  death  in  a  very  short  time,  as  is  true  also  of  hydrocyanic  acid. 
Strychnine  causes  frightful  convulsions,  while  morphine  produces  coma. 
The  simple  outline  here  given  serves  to  aid  in  grouping  poisons  accord- 
ing to  site  of  action: 

1.  Those  acting  locally: 

(a)  Corrosives. 

(b)  Irritants. 

2.  Those  acting  upon  the  blood,  or  blood  poisons. 

3.  Those  acting  upon  the  nervous  system,  or  nerve  poisons. 

4.  Those  acting  upon  special  organs: 

(a)  Upon  heart. 

(b)  Upon  kidneys. 

(c)  Abortives. 

Concerning  abortives,  it  should  be  noted  that  they  are  really  irritants. 
Among  other  effects  they  may  disturb  the  gravid  uterus,  but  this  is  only 
one  of  the  dangers  of  their  action.  As  a  class  they  must  be  regarded  as 
very  dangerous  agents  and  at  the  same  time  uncertain  as  to  any  special 
action. 

(For  symptoms  and  treatment  of  poisoning  by  the  various  substances, 
see  Table  of  Poisons  and  Antidotes.) 

Modes  of  death  are  appropriately  defined  at  this  place  as  related  to 
poisons. 

1.  Failure  of  Circulation.  Syncope  is  sudden  failure  of  the  circulation, 
due  to  depression  of  the  heart  from  various  causes.  It  may  be  temporary, 
as  in  case  of  ordinary  fainting,  or  it  may  be  complete,  due  to  paralysis 
of  the  heart. 

Asthenia  is  gradual  failure  of  the  circulation  by  depression  of  the 
heart,  as  occurs  in  fatal  cases  of  acute  infectious  diseases. 

2.  Failure  of  Respiration.  Asphyxia  is  the  condition  of  non-oxygen- 
ation  of  the  blood.  It  may  be  caused  by  complete  shutting  off  of  the  air 
(apnea),  as  in  drowning,  or  it  may  be  due  to  the  displacement  of  oxygen 
by  other  gases.     It  may  be  partial  or  complete. 

3.  Paralysis  of  Brain  Centres.  Coma  is  a  paralysis  of  the  conscious 
and  the  reflex  centres  of  the  brain.  It  may  be  caused  by  pressure,  as 
in  apoplexy,  or  it  may  be  due  to  the  action  of  a  narcotic. 

The  signs  of  death  usually  relied  upon  are  cessation  of  respiration, 
cessation  of  circulation  and  paralysis  of  pupil. 


262 


TABLE    OF  POISOXS  AXD  ANTIDOTES 


Table  op  Poisoxs  axd  Antidotes. 

(This  table  is  adapted  from  the  author's  Tables  for  Doctor  and  Druggist,  by  permission 
of  the  publisher,  E.  G.  Swift,  Detroit,  Mich.) 


Poison. 


Toxic 
dose. 


Action. 


\    Prominent  symp- 
toms. 


Antidotes  and  treatment. 
{Antidotes  in  italics.) 


Acid,  carbolic 
(phenol) 


Acid,  hj'drocyanic. 
Acid,  prussic 

(U.  S.  P.  2%). 

Bitter  almonds. 

Potass,  cyanide. 


Acid,  oxalic 

Soluble  oxalates. 


ni3o 


Mineral  acids.  _ 
Acid,  hydrochloric, 
nitric, 
sulphuric, 


Aconite    

Tincture  of  root. 
AconitLne. 


Ammonia    

Water    of 

ammonia  (10%). 
Stronger    water  of 

(28%). 
Carbonate   of  Am- 
monium. 
Arsenic  trioxide, 
Arsenous  acid, 
white  arsenic  .... 
Arsenic     disulphide, 
red  sulphide  of  arse- 
nic, realgar. 
Arsenic  trisulpyde, 
orpiment.       King's 
yellow. 
Arsenite    of    copper, 

Scheele's  green. 

Aceto-arsenite    of 

copper.  Paris  green. 

Schweinfurth  green 

Belladonna     (leaves, 

berries     or     root) 

Atropine    


ni22 
gr.  Ve 


f3l  * 
fatal. 


gr.  2 
fatal. 


Corrosive; 

systemic 
poison. 

Depresses 

brain  and 

heart. 


Irritant; 

general 

depressant 


Bromine. 
By  stomach 


By  inhalation  . 


gr.    V2-H 
fatal. 


f 
I 
Corrosive 

Depresses 

heart  and 

ner\'ous 

system. 

Irritant. 
Caustic. 


Escharotic 

irritant 

when 

diluted. 


Pain  followed  by  numb- 
ness; white  stain;  col- 
lapse; stupor;  dyspnea. 

Sudden  various  symp- 
toms of  depression; 
dyspnea. 


lAbdominal    pain, 
I  vomiting,     collapse, 
'   stupor. 

Thirst,  vomiting,  burn- 
I   ing  pain  in  throat  and 
'   stomach;   tissues  cor- 
roded;   more   or   less 
collapse. 


iTingUng  and  numb- 
j  ness;  slow,  weak  pulse; 
I  dyspnea;  pupil  usually 
I  dilated. 

Irritation  in  air  pass- 
ages and  stomach, 
with  pain,  vomiting 
and  purging;  prostra- 
tion. Odor  of  am- 
monia. 


Emesis:  Albumin,  alcohol,  sul- 
phate of  jyiagnesiuni  or  other 
soluble  sulphate.  Oil  or  other 
demulcents.     Stimulants. 

Artificial  respiration.  Stomach 
tube;  cold  douche  to  head  and 
chest,  or  alternate  with  hot. 
Ammonia  inhalation.  Mixture 
of  persulphate  and  protosulphate 
of  iron. 

Carbonate  of  lime  in  any  form, 
magnesia,  lime-water;  anodynes, 
demulcents,   stimulants. 

Glass  of  waterf  immediately  to 
dilute  acid,  foUow  by  lime- 
water,  magnesia,  soap  or  plaster 
from  wall;  no  carbonates.  De- 
mulcents, stimulants;  morph- 
ine hypoderm.  if  needed;  do 
not  use  stomach  pump. 

Empty  stomach.  Atropine,  ana- 
monia,  digitaHs  with  glonoin; 
strychnine.  Slight  galvanic 
shocks  recommended.  Tannin 
in  aconitine  poisoning. 

Water  immediately  to  dilute, 
follow  by  lemon-juice  or  vinegar. 
Inhalation  of  acetic  acid  vapor. 
Stomach  pump  should  not  be 
used.  Demulcents,  anodynes, 
stimulants. 


Deliriant 
narcotic ; 

dilates 
pupil  and 
paralyzes 
accommo- 
dation. 

Caustic; 
sedative 
to  nerve 
centres. 


Faintness;  gastro-  _  :Aid  emesis  (unless  vomiting  has 
intestinal  irritation.!  been  profuse)  by  the  use  of 
vomiting  and  purg-!  mustard  or  sulphate  of  zinc, 
ing;  thirst;  collapse;  May  wash  out  stomach  by 
cramps,  con\'ulsionsl  means  of  flexible  tube,  but 
or  coma.  In  some  stomach  pump  should  not  be 
cases  collapse  is  most  used.  Freshly  prepared  Ay- 
prominent  symptom,,  drated  sesquioxide  of  ironX  or 
in   others   stupor.  '    hydrated     sesquioxide     of     iron 

Some  cases  resemble  with  magnesia  freely,  and  fol- 
cholera.  Usually  the!  low  by  an  emetic,  then  by 
symptoms  do  not  de-i  castor  oil.  Demulcents,  ano- 
velop   quickly.  djmes,      stimulants,      external 

I   warmth. 

DrjTiess  of  mouth  and  Emetics  or  stomach  tube.  Tan- 
pharynx;  eyes  bright,  nic  acid,  animal  charcoal,  fol- 
pupils  dilated;  face  low  by  emetic,  and  later  by 
flushed;  rapid  respi-  castor  oil.  Heat  or  cold  ex- 
ration;  delirium,  con-  ternally;  or  alternately.  Arti- 
"vnlsions,  stupor.  I   ficial  respiration  and  stimulants 

if  necessary;  morphine  may  be 
I   of  value. 

Severe  _  symptoms     of  Dilute    with    large    draughts    of 
irritation;    depression    water.       Very  dilute  solutions 
of  nerve  centres;  par-;   of  alkalies;  ether;  brisk  cathar- 
alysis.  |   tic  alkalies. 
lAmmonia  by  inhalation. 


*  Poisonous  effect  depends  more  upon  concentration  than  upon  quantity. 

t  There  can  be  no  objection  to  the  use  of  water  in  sulphuric  acid  poisoning,  if  sufficient  is 
employed.  In  mixing  100  c.c.  of  water  at  70°  F.  with  10  c.c.  of  sulphuric  acid,  the  temperature 
increased  to  only  111°  F.;  and  in  mixing  200  c.c.  of  water  (a  glassful)  with  10  c.c.  of  sulphuric 
acid,  the  temperature  increased  to  only  94°  F. 

t  This  is  the  Ferri  Hydroxidum,  U.  S.  P.  To  prepare  it  freshly,  have  always  on  hand  in 
separate  bottles  200  c.c.  (f56J^)  of  Solution  of  Tersulphate  of  Iron  and  220  c.c.  (f§7)  of  Water 
of  Ammonia.  When  wanted,  dilute  the  solutions  largely,  mix  with  constant  stirring,  strain,  and 
wash  with  water,  then  give  freely  suspended  in  water.  The  Ferri  Hydroxidum  cum  Magnesii  oxido 
(U.  S.  P.)  is  a  preparation  of  similar  value.  It  is  prepared  by  mixing  the  iron  solution  with  a 
mixture  of  magnesia  and  water.  In  preparing  either  of  the  above,  either  tincture  of  chloride- 
or  Monsel's  solution  may  be  substituted  for  the  tersulphate. 


TABLE  OP  POISONS  AND  ANTIDOTES 


263 


Poison. 


Toxic 
dose. 


Action. 


Prominent  symp- 
toms. 


Camphor 


Cannabis  indica    . 


Cantharides 

Tincture. 

Cantharidin  (active 
principle) . 


Carbolic  acid.       jSee 

Acid,  carbolic. 
Carbonic  anhy-  _ 

dride,*  carbonic 

acid  gas. 

Carbonic  oxidef    •  ■  • 
Charcoal  gas. 
Coal  gas. 
Illuminating  gas. 


Castor-oil  beans  .  .  .  . 
(Seeds  of  Ricinus 
communis.) 
Chloral  hydrate  . .  . . 


Chloroform    . 
By  stomach 


By  inhalation  .... 


Coal  gas.      See  Car- 
bonic oxide. 
Copper  salts 

Arsenite.       See 
Arsenic. 

Carbonate, 
"Natural"     verdi- 
gris. 

Subacetate,     verdi- 
gris. 


gr.  20 


gr.  23 

fgl 
fatal. 


Three 
seeds 
fatal, 
gr.  30 


fSl  fatal 
to  child. 

f54 

fatal  to 

adult. 

rrii5 

quickly 

inhaled 

has  been 

fatal 


34 


Disturbs 

brain  and 

nerve 

centres. 

Intoxicant 


Irritant; 
sometimes 
aphrodisiac 


Regarded 

by  some  as 

narcotic. 

Destroys 
oxygen- 
carrying 
power  of 
the  red 
blood  cor- 
puscles. 


Irritant. 


Hypnotic; 
sedative; 
paralyzes 

nerve 
centres. 
Narcotic. 


Locally 
irritant; 
anesthetic 


Anesthetic; 
paralyzes 

nerve 

centres; 

has  a  direct 

paralyzing 

effect  upon 

heart. 

Irritant. 


Vertigo;   pain  in 
stomach;   delirium  or 
stupor;  convulsions. 

Hilarity;  mental  con- 
fusion; pupils  dilated; 
drowsiness. 

Gastrointest.  irritation 
with  pain,  vomiting 
and  purging;  pain  in 
loins;  severe  irritation 
of  genitourinary  or- 
gans; sometimes  erotic 
excitement;  collapse, 
stupor,  coma;  in  some 
cases  delirium  or  con- 
vulsions. 

Headache,    giddiness 
drowsiness;     cyanosis 
if  oxygen  is  excluded; 
coma. 

Headache,  vertigo, 
prostration,  vomiting, 
dyspnea;  feeble  and 
rapid  pulse,  stupor; 
in  some  cases  convul- 
sions. 


Severe  gastrointestinal 
irritation. 

Stupor;  pupils  at  first 
contracted,  later  di- 
lated; temperature  re- 
duced; respirations 
slow,  or  later  may  be 
rapid  and  shallow. 


When  taken  by  the 
stomach:  gastric  irri- 
tation, vomiting,  odor 
of  chloroform.  Later, 
stupor,  coma. 

When  inhaled:  loss  of 
consciousness,  syn- 
cope sometimes  early; 
profound  narcosis. 
Death  by  failure  of 
heart  or  respiration. 


Antidotes  and  treatment. 
{Antidotes  in  italics.) 


Gastric  irritation  with 
pain  and  vomiting 
of  greenish  matter, 
purging;  jaundice  in 
some  cases;  convul- 
sions or  paralysis  may 
follow. 


Eme.sis.  Follow  by  castor  oil 
or  sulphate  of  magnesium. 
Stimulants  if  necessary  to 
support  nerve  centres. 

Meet  indications  as  they  arise. 
(There  is  no  case  on  record  of 
fatal   poisoning  by  this  drug.) 

Emesis.  Stomach  tube  may  be 
used.  Demulcents.  No  oils 
should  be  employed,  as  they 
dissolve  cantharidin  and  favor 
its  absorption.  Anodynes  by 
the  rectum;  opium,  cocaine, 
belladonna.  Morphine  hypo- 
dermically,  or  anesthetics  if 
suffering  is  intense.  Leeches 
to  hypogastrium.  Warm  baths; 
mild   diuretics   and   cathartics. 

Supply  fresh  air  or  oxygen. 
Artificial  respiration  and  stim- 
ulants if  necessary. 

The  hemoglobin  being  so  altered 
as  to  be  incapable  of  taking 
up  oxygen,  the  treatment  by 
fresh  air  and  oxygen  is  not  so 
successful  as  in  simple  asphyxia; 
still  this  means  of  giving 
oxygen  to  the  blood  cells  that 
remain  uninjured  should  be 
employed.  In  urgent  cases 
transfusion  of  blood 
Emesis,  demulcents,  anodynes 
and  stimulants  if  necessary. 

Emesis  or  stomach  tube.  Ex- 
ternal warrnth  very  important! 
Arouse  patient.  Stimulate  re- 
flexes by  external  application 
of  mustard,  friction,  slapping 
smartly;  faradization;  atropine, 
strong  coffee,  strychnine,  arn- 
monium  carbonate  and  digi- 
talis if  urgent ;  artificial  or 
forced  respiration;  inhalation 
of  oxygen  very  useful. 

Emetic  or  use  of  stomach  tube. 
Arouse  patient;  recumbent 
posture.  Stimulants;  strych- 
nine, caffeine,  digitalis;  ex- 
ternal warmth,  artificial  respi- 
ration if  necessary. 

Stop  inhalation  and  supply  fresh 
air.  Head  low  to  favor  gravi- 
tation of  blood  to  the  brain. 
Artificial  respiration,  external 
warmth  and  friction;  faradiza- 
tion of  diaphragm  and  other 
muscles  of  respiration ;  massage 
of  heart;  strychnine,  caffeine, 
digitalis. 

Aid  emesis.  Albumin  freely  is 
best  antidote.  Milk,  mucil- 
aginous drinks;  ferrocyanide  of 
potassium  if  pure;  opium; 
stimulation  if  necessary. 


*  An  atmosphere  containing  1  to  2%  of  carbonic  anhydride,  -with  a  corresponding  diminution 
of  oxygen,  is  poisonous;  with  5  to  10%  of  carbonic  anhydride,  and  oxygen  correspondingly  lessened, 
death  will  occur,  while  it  requires  10  to  20%  to  extinguish  a  flame. 

t  Carbonic  oxide  is  more  poisonous.  According  to  Sollmann  (Pharmacology)  it  combines  with 
hemoglobin  200  times  more  readily  than  does  oxygen. 

X  Brunton  and  Strieker  found  that  animals  which  had  received  a  dose  of  chloral  that  would 
certainly  kill  them  if  they  were  left  exposed,  recovered  when  wrapped  up  in  cotton-wool,  and  if 
the  dose  were  increased  so  as  to  kill  the  animal  even  when  thus  wrapped  up,  it  could  still  be  kept 
alive  by  being  put  into  a  warm  place  so  as  to  keep  up  its  temperature  artificially.  A  still  larger 
dose  was,  as  a  matter  of  course,  necessarily  fatal. 

II   See  note  under  Opium. 


264 


TABLE   OF   POISOXS  AXD   ANTIDOTES 


Poison. 


Toxic 
dose. 


Action. 


Prominent    symp- 
toms. 


Antidotes  and  treatment. 
(Antidotes  in  italics.) 


Sulphate,     blue 
^■it^iol. 
Corrosive  subKmate 
See   Mercuric    chlo- 
ride. 
Creosote , 


Croton  oil 


Cyanide  of  potas- 
sium. See  Acid, 
hydrocyanic. 

Elaterium    

Elaterin        (several 
times  stronger 

than  elaterium). 
Ether,  by  stomach 

Ether,  by  inhalation 


Formalin 


Fungi* . 

Amanita  muscaria, 
Agaricus  phalloides, 
and  others.  (The 
irritant  principle  is 
destroyed  by  boil- 
ing, drying,  or  by 
acids,  alkahes  or 
alcohol;  but  the 
narcotic  principle, 
viuscarine,  resists 
the  action  of  heat, 
drying,  or  these  re- 
agents). 

Hyoscyamus,      hen- 
bane. 
Hyoscyamine. 
Hyoscine. 

Iodide  of  potassium 
(acute  poisoning). 


Iodine  (acute  poison- 
ing). 

Tincture. 
Iron  salts 

Chloride,  tinct.  of. 

Sulphate,  copperas. 


Laudanum. 
See  Opium. 

Lead  salts   

Acetate.     Sugar  of 

lead. 
Carbonate     White 

lead. 
Oxide,   red.        Red 
lead. 
Mercuric         chloride 
(Corrosive        subU- 
mate.      Bichloride 
of  mercury.) 


Mercuric    cyanide. 
(Similar  to  above.) 


ol  fatal 


TTISO 
fatal. 


gr.  .3 

fatal. 


Similar  to 

belladonna. 

but  more 

hypnotic. 

Irritant. 


Irritant. 


Irritant. 


Irritant 
in  acute 
poisoning. 


Irritant. 

Irritant; 

drastic 

cathartic. 


Drastic 
cathartic. 


Irritant. 
Anesthetic 


Irritant. 


Irritant; 
narcotic. 


Gastrointestinal      irri-  DUute  freely  with  water,  then 
tation.  '   emesis;  follow  by  demulcents. 

Violent        gastrointes-  Demulcents,      anodynes;      mor- 
tinal  irritation;  purg-    phine  hypodermicaUy. 
ing,       collapse,       and 


other  symptoms 
sembUng  those 
cholera. 

Violent    vomiting    and  Anodynes, 
purging,    with    severe    mically, 
griping;  collapse.  '   lants. 


morphine    hypoder- 
demul  cents,     stimu- 


Gastrointestinal 

tation. 
Narcosis;    cessation   of 

respiration. 


Severe  pain  in  throat 
and  stomach;  vomit- 
ing. 


Gastrointestinal  irri- 
tation, pain  and  vom- 
iting; various  nervous 
symptoms;  headache, 
vertigo,  ^■isual  cUs- 
turbances;  in  some 
cases  delirium  or 
coma. 


Stimulate    elimination;    demul- 

!   cents;   stimulants  if  needed. 

Stop  inhalation;  abundance  of 
fresh  air;  artificial  respiration, 
external  warmth,  strychnine, 
caffeine;   faradization. 

Dilute  poison  with_  warm  water 
freely.  If  vomiting  does  not 
occur  the  stomach  should  be 
thoroughly  washed  by  means 
of  tube.  Demulcents,  ano- 
djTies.     Ammonia  as  antidote. 

Emetic  and  cathartic  (common 
salt  or  mustard  as  emetic); 
demulcents  and  other  treat- 
ment according  to  inchcations; 
atropine  hypodermicaUy  is 
recommended  as  physiologic 
antidote.  Tannic  acid  has 
been  thought  to  be  useful. 
Purified  animal  charcoal. 


Same  as  in  belladonna  Same  as  for  belladonna  poison- 
poisoning.  I   ing. 


Gastrointestinal       irri- Aid  emesis.     Demulcents,  dilu- 

tation,   vomiting   and'   ents,    anodynes,    stimulants   if 

purging;  headache,  in    needed. 

some  cases  saHvation; 

frequently    an    erup-, 

tion;  prostration, 
Similar  to  above. 


Gastric   irritation   and 
pain;  vomiting. 


Gastrointestinal  irri- 
tation with  severe 
coUc,  vomiting,  con- 
stipation; if  severe, 
convulsions  may 
occur. 


Corrosive.  Symptoms  occur^  quite 
promptly;  burning  in 
throat  and  stomach, 
nau.sea  and  vomiting; 
abdomen  swollen  and 
tender;  severe  purg- 
ing with  straining; 
discharges  frequently 
bloody;  collapse, 

stupor,  convulsions,     j 


'.Starch  freely,  foUow  by  evacu- 
ants;  other  treatment  as  above. 

Dilute  with  draught  of  water 
immediately;  dilute  solution 
of  sulphide  of  potassium,  so- 
dium,  or  ammonium,.  Aid 
emesis  by  large  draughts  of 
warm  water;  demulcents,  ano- 
dynes;  stimulants. 

Aid  emesis.  Sulphate  of  mag- 
nesium or  other  soluble  sul- 
phate, followed  by  emetic; 
stimulate  sweating  by  exter- 
nal warmth;  later  iodide  of 
potassium  or  very  dilute  sul- 
phuric acid,  or  both. 

Albumin  freely.  (White  of  one 
egg  to  each  0.25  gm.  (4  grains) 
of  poison  swallowed.)  As  a 
substitute  for  albumin  v;heat- 
flour  paste  or  milk.  Emesis 
after  poison  is  neutralized; 
demulcents,  morphine  hypo- 
dermicaUy; stimulants  inter- 
nally and  heat  or  friction  exter- 
nallj';  continue  white  of  egg 
for  one  to  two  weeks. 


*  For  an  extensive  and  illustrated  description  of  edible  and    poisonous   fungi,  see    Referencw^ 
Handbook  of  the  Medical  Sciences,  vol.  ui.,  New  York. 


TABLE  OF  POISONS  AND  ANTIDOTES 


265 


Poison. 


Toxic 
dose. 


Mercury  salts  ...  . 
(The  salts  other 
than  bichloride  and 
cyanide  are  toxic 
in  proportion  to  sol- 
ubility.) 

Morphine. 
See  Opium. 

Nitrite  of  amyl  .... 

Nitroglycerin, 
glonoin. 


Nux  vomica 

Alcoholic     extract 
Strychnine 


Opium . 

Camphorated  tine 
ture.  Paregoric 
(contains  about  34 
grain  of  opium  to  a 
fluidrachm) . 
Tincture.  Lauda 
num.  (This  and  all 
other  official  fluid 
preparations  ex 
cept  paregoric  con- 
tain 10%  of 
opium.) 

Codeine. 

Morphine 

Narcotine. 


gr.  30 
gr.  3 
gr.  }4 


gr.  4-5 
fatal. 


Action. 


Prominent   symp- 
toms. 


Antidotes  and  treatment. 
(Antidotes  in  italics.) 


Irritant. 


Increases 

irritability 

of  spinal 

cord. 


1st  stage. 


Symptoms  of  gastro- 
intestinal irritation  in 
varying  degree,  ac- 
cording to  the  amount 
and  solubiUty  of  salt. 


Flushing  of  face,  suc- 
ceeded by  pallor;  pu- 
pils dilated;  respira- 
tion irregular;  pulse 
weak. 

Muscular  twitching, 
tonic  spasms,  with 
intervals  of  rest;  ex 
treme  extension  of 
back  so  that  body 
may  rest  upon  the 
heels  and  head;  cor- 
ners of  the  m9uth 
drawn  up;  later  jaws 
become  fixed;  death 
by  asphyxia  or  ex- 
haustion; conscious- 
ness remains  until 
near  death. 

Often  slight  stimiila- 
tion  or  excitement. 


gr.  H 
fatal. 


2d  stage, 
narcotic. 


Intoxication,  drowsi- 
ness and  stupor;  pu- 
pils are  contracted; 
pulse  slow  and  fuU; 
respiration  slow  and 
often  stertorous;  face 
flushed,  sometimes 
cyanosed;  uncon 

sciousness  seems  com 
plete,  but  patient  can 
be  partially  aroused 
during  this  stage  by 
shaking  or  shouting. 


Prompt  emesis  by  mustard  or 
sulphate  of  zinc;  follow  by 
albumin  or  milk,  after  which 
induce  further  emesis  and  pur- 
gation. Meet  other  indications 
as  they  arise. 


Cold  to  head,  artificial  respira- 
tion, ergot,  strychnine,  digi- 
taUs;  warmth  externally. 


If  seen  early  evacuate  stomach, 
then  give  tannic  acid  freely, 
and  follow  by  a  quick  emetic. 
Bromide  of  potassium  in  large 
doses,  gm.  8-16  (32-4)  and 
chloral,  gm.  1-2  (gr.  15-30) 
every  half-hour  if  necessary; 
keep  patient  very  quiet.  _  When 
convulsions  are  severe,  inhala- 
tions of  ether  or  chloroforrn. 
Forced  respiration*  if  asphy.xia 
threatens;  curarine  hypoder- 
mically  has  been  suggested. 
Bladder  should  be  emptied. 

Evacuate  stomach  by  use  of 
mustard  stirred  up  in  luke- 
warm water,  aided  by  sul- 
phate of  zinc,  gm.  1..30-2  (gr. 
20-30)  if  vomiting  does  not 
speedily  occur;  meanwhile 
tannic  acid  should  be  given 
freely,  or  potassium  permarifja- 
nate.  Wash  out  stomach.  The 
stomach  tube  may  be  useful. 
Apomorphine  0.005  gm.  (^lu 
gr.)  hypodermically  as  emetic 
S  patient  cannot  swaUow. 

Maintain  respiration:  1.  By 
arousing  patient  and  stimu- 
lating reflex  actixdty  by  ex- 
ternal stimulation,  shouting, 
smart  slapping,  frictions;  far- 
adization, alternate  douche  of 
quite  hot  (as  hot  as  the  hand 
can  bear)  and  ice-cold  water 
to  head  and  chest;  cautious 
inhalations  of  ammonia.  2. 
By  strong  coffee  freely  or  caf- 
feine hypodermically;  atropine 
hypodermically  in  ordinary 
doses  only,  to  be  repeated  ac- 
cording to  the  state  of  the 
respiration  ;  strychnine.  3.  If 
respiration  is  slow,  or  rapid 
and  shallow,  so  that  in  either 
case  insufficient  air  enters  the 
lungs,  artificial  respiration  or 
forced  respirationf  must  be  em- 
ployed without  intermission 
until  proper  respiration  is 
established;  inhalation  of  oxy- 
gen; catheterization  should  not 
be  neglected,  and  large  ene- 
mata  of  warm  water  may  aid 
elimination. 


*  See  note  under  Opium. 

t  The  principle  of  forced  respiration,  as  practised  in  physiologic  experiments  has  been  apphed 
to  the  treatment  of  opium  poisoning  by  Dr.  George  E.  Fell,  of  Buffalo,  N.  Y.  The  apparatus 
used  consists  of  bellows,  face-mask,  and  the  necessary  rubber  tubes,  with  stopcock  arranged  to 
facilitate  imitation  of  the  natural  respiratory  rhythm,  and  to  allow  the  addition  of  oxygen  to 
the  inspired  air.  Dr.  Fell  has  employed  the  method  in  eleven  cases  that  seemed  hopeless  with 
the  use  of  ordinary  means  of  treatment  and  in  three  cases  that  were  absolutely  hopeless.  Of  the 
eleven  cases  eight  were  saved.  High  authorities  have  pronounced  forced  respiration  as  no  better 
than  the  usual  methods  of  artificial  respiration,  but  the  experience  given  above  would  seem  to 
place  the  method  among  the  most  effectual  means  at  our  command  for  resuscitation  of  seemingly 
hopeless  cases  of  opium  poisoning. 


266 


TABLE  OF  POISONS  AND  ANTIDOTES 


Poison. 


Toxic 
dose. 


Action. 


Prominent   symp- 
toms. 


Antidotes  and  treatment. 
(Antidotes  in  italics.) 


Oxalates.   ")  See 
Oxalic          >   Acid, 

acid.        )  oxalic. 

Paregoric.  See 

Opium. 

Paris  green.  See 

Arsenic. 

Phosphorus  


Potassa 

Soda. 

(Soda  as  a  poison 
is  very  similar  to 
potassa.) 

Liquor  potassse. 

Liquor  sodiB. 

Commercial  potash 
and  soda  are  im- 
pure carbonates 
containing  much 
free  alkali. 
Potassium  bitar- 

trate.      Cream    of 
tartar. 
Potassium  chlorate 


Potassium  nitrate 


Potassium   sulphate, 
Prussic  acid.     See 

Acid,  hydrocyanic. 
Red  lead.    See  Lead 

salts. 
Red  precipitate. 

See  Mercury  salts. 


Third 

stage, 

paralyzant. 


gr.  1 
fatal. 


;4* 


52 

fatal. 


o6 

fatal. 


olO 
fatal. 


Irritant. 


Caustic. 


Prostration,  coma;  res- 
piration may  become 
more  rapid  and  shal- 
low; pulse  weaker  and 
more  rapid;  face  is 
pallid  and  sometimes 
cyanosed;  before 

death  occurs  pupils 
become  dilated;  re- 
flexes aboHshed;  con- 
vulsions may  occur; 
death  usually  by  fail- 
ure of  respiration. 


Irritant 
purgative. 

Irritant; 

believed  to 

produce 

serious 

changes  in 

the  blood. 


Irritant. 


Irritant. 


.Sustain  circulation.  Strychnine, 
caffeine,  external  heat  and  fric- 
tion; digitalis  if  heart-failure 
threatens;  strong  infusion  of 
coffee  by  enema;  keep  up  arti- 
ficial or  forced  respiration  with 
or  without  oxygen.  Morphine 
is  eliminated  into  the  storaach, 
therefore  it  should  be  washed 
out  frequently  with  a  solution 
of  potassium  -permanganate. 


Symptoms  usually  do 
not  appear  until 
after  a  few  hours; 
then  weakness, nausea 
with  vomiting,  and 
other  symptoms  _  of 
gastric  irritation; 

vomited  matters  are 
luminous  in  the  dark, 
and  have  the  odor  of 
phosphorus;  later 

jaundice  and  in  some 
cases  delirium,  con- 
vulsions, coma;  hem- 
orrhages may  occur; 
temperature  may  be 
greatly  reduced.  In 
some  cases  death  oc- 
curs early  and  symp- 
toms are  not  typical. 

Burning  and  pain  ir 
stomach  and  abdo- 
men; severe  vomiting 
and  purging;  prostra- 
tion. 


Sulphate  of_  copper,  0.20  gm._  (3 
grains)  in  dilute  solution 
every  five  minutes  as  antidote 
and  to  induce  emesis;  if  at  hand 
crude  acid  French  oil  of  turpen- 
tine, or,  as  a  substitute  for  it, 
old  oxidized  oil  of  turpentine, 
and  follow  by  a  quick  saline 
cathartic.  Ordinary  turpentine 
is  of  no  value  and  may  be 
dangerous,  as  oils  should  be 
avoided  because  they  are  sol- 
vents for  phosphorus.  After 
poison  is  neutraUzed  and  re- 
moved employ  demulcents; 
mucilaginous  drinks,  anodynes 
and  stimulants  if  necessary. 


Pi.  large  draught  of  water  im- 
mediately, and  follow  with 
diluted  vinegar  or  lemon-juice; 
albumin,  oils,  acidulated  de- 
mulcent drinks;  opium  or  mor- 
phine to  reUeve  pain;  stimu- 
lants. 


Gastrointestinal    irri- 
tation. 

Gastrointestinal  irri- 
tation with  pain  and 
vomiting;  irritation 
CI  kidneys,  often  -with 
suppression  of  urine 
and  other  symptoms 
of  acute  nephritis; 
cyanosis  and  nervous 
symptoms  may  occur. 

Gastrointestinal  _  irri- 
tation with  ^aolent 
vomiting,  and  in  some 
cases  purging;  mus- 
cular weakness,  col- 
lapse; various  nerv- 
ous symptoms  may 
occur. 

Similar  to  above. 


Demulcents;  chalk  or  magnesia 
mixed  with  water;  opium. 

Demulcents,  saline  purgatives 
and  diuretics;  calomel  inay 
be  valuable;  coffee  or  caffeine; 
stimulants  moderately;  heat 
externally;  transfusion  of 
blood  is  recommended. 


Dilute  at  once  with  large 
draught  of  warm  water  and 
promote  emesis;  give  brisk 
non-irritating  cathartic;  follow 
by  demulcent  drinks;  keep 
patient  warm;  anodynes  and 
stimulants  as  needed.  If  col- 
lapse occurs,  warmth,  friction, 
or  mustard  externally. 

Same  as  for  potassium  nitrate. 


*  Poisonous  effect  depends  rather  upon  concentration  than  quantity. 


TABLE  OF  POISONS  AND  ANTIDOTES 


267 


Poison. 


Toxic 
dose. 


Action. 


Prominent  symp- 
toms. 


Antidotes  and  treatment. 
(Antidotes  in  italics.) 


Silver  nitrate 

Soda.     See  Potassa. 
Stramonium. 
(Similar    to     bella- 
donna as  a  poison.) 
See  Belladonna. 
Strychnine.  See  Nux 

vomica. 
Sugar  of  lead.     See 
Lead  salts. 

Tobacco 

Nicotine  (one  of 
the  most  active 
poisons  known.) 


Turpentine,  oil  of. 


Verdigris. 

See  Copper  salts. 

White  lead. 

See  Lead  salts. 

Zinj  chloride 

"Burnett's   Disin- 
fecting Fluid"  has 
200  grains  of  zinc 
chloride     in     one 
fluidounce. 

Zinc  sulphate     .... 


gr.  30 
A  few 
drops 
prob- 
ably 
fatal. 


32-4 


Irritant.  Severe  gastric  irri- j Solution  of  common  salt  freely; 
tation,  vomiting,  con-  albumin;  mucilaginous  drinks; 
vulsions;  later  diar-  other  treatment  as  the  case 
rhea.  may  require. 


Irritant; 
sedative. 


Irritant; 
narcotic. 


Corrosive. 


Irritant; 
emetic. 


Nausea,  vomiting,  in 
some  cases  purging; 
pain  in  stomach; 
prostration;  delirium; 
cramps;  rapid,  weak 
pulse;  collapse. 

Gastric  irritation; 
vomiting  and  purg- 
ing in  some  cases; 
irritation  of  urinary 
organs  with  urine 
lessened;  unconscious- 
ness; convulsions;  col- 
lapse. 


Violent  irritation  of 
stomach  immediately, 
with  vomiting  and 
pain;  tissues  corroded; 
nervous  symptoms ; 
collapse. 

Gastric  irritation; 
vomiting. 


Aid   emesis   by  large   draughts 

of  warm  water;  tannic  acid; 
strychnine,  demulcents,  ano- 
dynes, stimulants,  external 
warmth,  etc. 

Evacuate  stomach  by  use  of 
mustard  or  stomach  tube,  or 
if  vomiting  has  occurred  aid 
by  large  draughts  of  warm 
water;  siilphate  of  mag- 
nesium as  cathartic;  hot  fo- 
mentations to  loins;  demul- 
cents; stimulants  and  anodynes 
if  needed.  Warmth  and  friction 
externally. 

A  glassful  of  milk  or  water 
immediately  to  dilute  poison; 
albumin;  dilute  solution  of  car- 
bonate of  potassium  or  sodium; 
demulcents,  anodynes,  stimu- 
lants. 

Dilute  solution  of  carbonate  of 
potassium  or  sodium,  or  tannic 
acid;  albumin;  demulcents; 
anodynes  and  stimulants  if 
necessary. 


INDEX  OF  DRUGS. 


OFFICIAL  DRUGS  AND  PREPARATIONS  ARE  GIVEN  THEIR  PHARMACOPEIAL 

TITLES. 

(Doses  and  uses  are  adapted  from  the  author's  Tables  for  Doctor  and  Druggist,  by  permission 
of  the  publisher,  E.  G.  Swift,  Detroit.) 


Abbreviations ; 


*  Unofficial. 


Ac.      =  acid. 
Al.       =  alkaline. 
Insol.  =  insoluble. 


Misc.  =  miscible. 
N.  =  neutral. 
Part.  =  partly  soluble. 


sol. 


SI 
V.  s. 
Spar. 


:  slightly  soluble. 

=  very  soluble. 

=  sparingly  soluble. 


Solubility  in 

Dose. 

Page 

in 

Drug. 

Reac- 

Gm. or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

90 

Acacia,  gum  Arabic 

2 

insol. 

Demulcent.       In    irri- 

Mucilago       acacia; 

ac. 

freely 

tation    in     digestive 

34%. 

tract;    in    emulsions 

Syrupus,  10  J^. 

ac. 

freely 

to  hold  oil  or  other 
matter  in  suspension. 

137 

Acetanilidum,     anti- 

N. 

180 

2.5 

gr.  1-10 

0.06-0.60 

Antipyretic.  Anodyne. 

219 

febrin. 

In  acute  fevers  cau- 

Pulvis     acetaniUdi 

gr.  2-15 

0.12-1 

tiously.        In    head- 

compositus. 

aches.        Locally    in 
powder  as  antiseptic. 

152 

*Acetozone,         ben- 
zoyl-acetyl       per- 
oxide, benzozone. 

si.  sol. 

gr.  1-5 

0.06-0.30 

Antiseptic.    Bleaching 
agent. 

219 

Acetphenetidinum, 
phenacetin. 

925 

12 

gr.  2-10 

0.12-0.60 

Antipyretic.  Anodyne. 

Acidum       aceticum, 

ac. 

local 

Solvent.        To    soften 

.  ?•?%■ 

use. 

callous  tissue,  corns, 

Acidum        aceticum 

ac. 

etc.     Hemostatic. 

dilutum,  6%. 

72 

Acidum        aceticum 
glaciale,  99%. 

Acid,  arsenqus. 
See  Arseni  trioxid. 

ac. 

Caustic. 

129 

Acidum  benzoicum^. 

ac. 

281 

2 

Antiseptic.     The  acid 

122 
115 

Ammonii    benzoas. 
lathii  benzoas. 
Sodii  benzoas. 
Acidum     _  boricum, 
boric  acid. 
Sodii  boras,  borax. 

N. 
si.  ac. 

N. 
si.  ac. 

al. 

10.5 
3 

1.(1 
18 

20.4 

25 

13 

43 

15.3 

insol. 

■  gr.  5-20 

gr.  5-15 
gr.  5-30 

0.30-1.30 

0.30-1 
0.30-2 

and  its  combinations 
given    internally    as 
urinary  antiseptics. 
Antiseptic.    Saturated 
aqueous   solution   as 
mouth    wash    or    to 

123 
122 

Glyceritum    boro- 
glycerini  (a  soln.  of 
boroglycerin,  31% 
boric  acid). 

N. 

local  use 

purulent     inflamma- 
tions.       Borax     has 
similar  uses,  is  alka- 
line and  antiseptic. 

Acidum      camphori- 

ac. 

125 

sol. 

gr.  10-30 

0.60-2 

To      control      night- 

cum. 
Acid,  carbolic.      See 

sweats   of   phthisis. 

Phenol. 

Acid,  chromic.      See 

Chromii  trioxid. 

129 

*Acid,  cinnamic. 

ac. 

si.  sol. 

sol. 

Antiseptic. 

209 

Acidum  citricum. 

ac. 

0.54 

1.08 

gr.  5-30 

6.30-2 

Syrupus  acidi  citrici. 

f5i-4 

4-15 

scurvy,   as  a  substi- 

1%. 

tute  for  lemon-juice. 

107 

Acidum  galHcum. 
*Glycerite. 
♦Ointment,  10%. 

ac. 

84 

5 

gr.  5-20 

0.30-1.30 

Astringent.        As  sys- 
temic          hemostatic 
where     local     treat- 
ment is  impossible. 

(269) 


270 


INDEX  OF  DRUGS 


Page 

Drug. 

Reac- 

Solubility in 

Dose. 

in 

Gm.  or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

71 

Acidum  fivdrochlori- 

ac. 

Caustic. 

262 

cum,  31.9%. 

208 

Acidum  hydrochlori- 
cum  dilutum,10% 

ac. 

ni5-20 

0.30-1.20 

Digestant.  When 
acidity  of  gastric 
juice  is  deficient. 

207 

Acidum   hydrocyan- 

ac. 

mi-3 

0.06-0.20 

Sedative.        In   cough 

218 

icum  dilutum,  dil. 

and  vomiting.      Use 

262 

prussic  acid,  2%. 

with  caution. 

73 

Acidum        lacticum, 

75%-      .     .         „ 
Acid,  muriatic.     iSee 
Acid  hydrochloric. 

ac. 

sol. 

sol. 

nil5-60 

1-4 

Antiseptic.  Solvent. 
Applied  to  diphther- 
itic membrane  and 
in  pyorrhea  alve- 
olaris. 

71 

Acidum        nitricum, 

ac. 

Caustic.       Locally   to 

262 

aqua  fortis,  68%. 

sloughing  ulcers,  and 

208 

Acidum         nitricum 
dilutum,  10%. 

ac. 

Tn5-20 

0.30-1.20 

caries  of  bone.  Di- 
lute acid  as  tonic  and 

71 

Acidum.  nitrohydro- 
chloricum,       aqua 
regia. 

ac 

stimulant  to  hver  and 
digestive  secretions. 

209 

Acidum  nitrohydro- 
chloricum  dilutum 

ac. 

ni5-20 

0.30-1.20 

Tonic.     Digestant. 
Same  uses  as    dilute 
hydrochloric         and 
nitric  acids. 

Acidum  oleicum. 

si.  ac. 

insol. 

sol. 

extern. 

To  prepare  oleates. 

262 

*Acid,  oxalic. 
Acid,  phenic.     »Siee 

Phenol. 
Acidum     phosphori- 

cum,  85%. 

ac. 
ac. 

8 

2.5 

Irritant  poison.  As 
reagent.  To  remove 
stain  of  potassium 
permanganate,  or  of 
rust,  fruits,  and  ink. 

210 

Acidum     phosphori- 
cum  dilutum,  10% 

ac. 

rn5-30 

0.30-2 

Restorative  tonic.  In 
neurasthenia. 

*Acid,  picric,  carbo- 

ac. 

86 

sol. 

Reagent.     Coloring 

zoic  acid. 

agent. 

129 

Acidum  salicylicum. 
*Ointment,  10  %. 

ac. 

308 

2 

gr.  5-30 

0.30-2 

extern. 

Antiseptic.  Antipy- 
retic.   In  solution  as 

130 

Sodii  sahcylas. 

si.  ac. 

0.8 

5.5 

gr.  5-30 

0.30-2 

preservative.  Sodi- 
um salicylate  in 
acute  rheumatism. 

71 

Acidum        sulphuri- 

ac. 

Corrosive.  Dilute  acid 

262 

cum,  92.5%. 

as  astringent. 

209 

Acidum  sulphuricum 
dilutum,    10%. 

ac. 

m5-20 

0.30-1.20 
(' 

The  aromatic  acid  as 

209 

Acidum    s.    aromati- 
cum. 

Tn2-15 

0.12-1  ^ 

solvent  for  quinine 
sulphate. 

153 

Acidum       sulphuro- 
sum,    6%    of    sul- 
phur  dioxide   gas. 

ac. 

f3J^-2 

2-8 

Disinfectant.  Bleach- 
ing agent.  In  para- 
sitic    skin     diseases. 

154 

Sodii  bisulphis. 

ac. 

3.5 

70 

] 

Internally  in  form  of 

140 

Sodii  sulphis. 

N. 

9 

si.  sol. 

[gr.  5-30 

0.30-2 

sulphites  or  hyposul- 

141 

Sodii       thiosulphas 

N. 

0.35 

insol. 

phites,  as  antiseptic. 

154 

(hyposulphite). 

J 

96 

Acidum      tannicum. 

ac. 

0.33 

0.22 

gr.    1-30 

0.06-2 

Astringent.       Applied 

111 

CoUodium      stypti- 
cum,  20%. 

local  use 

as  hemostatic.  To 
contract     tissue,     as 

93 

Glyceritum       acidi 

tannic,  20%. 
Unguentum,  20%. 
Trochisci, 

local  use 

local  use 
gr.  1  each 

in  catarrhal  pharyn- 
gitis, and  to  check 
secretion,  as  in  diar- 
rhea. 

209 

Acidum  tartaricum. 

ac. 

0.7 

2 

gr.  5-30 

0.30-2 

Substitute  for  citric 
acid   or  lemon-juice. 

73 

Acidum         trichlor- 
aceticum. 

ac. 

V.  s. 

V.  s. 

Caustic.  Test  for  al- 
bumin. 

218 

Aconitum,       aconite 

gr.  H-2 

0.03-0.12 

Cardiac  sedative.     To 

262 

root  (a.  napellus). 

reduce  arterial  press- 

Plate 

♦Extract, 

gr.  Vw-H 

0.006-0.015 

ure  in  inflammations 

XIV. 

Fluidextractum 
aconiti. 

WA-2 

0.03-0.12 

and  sthenic  fevers. 
Locally    sedative   in 

63,65 

Tinctura  aconiti. 

)T15-15 

0.30-1. 

form  of  plaster,  tinc- 

Aconitina, aconitia. 

al. 

3200 

22 

gr.  1/400 

0.00015 

ture,  or  the  oleate  of 

*01eate  of  aconitine. 

local  use 

aconitine,  in  neural- 

2%. 

gia. 

Actol.      See  Argenti 

lactas. 

91 

Adeps,  lard. 
Adeps  benzoinatus. 

extern. 

As  basis  for  oint- 
ments. Benzoinated 
lard  keeps  better- 
than  ordinary. 

INDEX  OF  DRUGS 


271 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Water    Alcohol 


Dose. 


Gm.  or 
c.c. 


91 


107 


107 


185 
Plate 


198 


230 


156 

188 


127 
Plate 

viii. 
98 
98 
98 


100 


Plate 
xviii. 


Plate 
xviii. 


102 


80 
103 


Adeps  lanae,  lano 
lin  (purified  fat 
of  sheep's  wool). 

Adeps  1.  hydrosus, 
hydrous    wool-fat, 
contains         about 
30%  of  water. 

♦Adrenalin 

(claimed  to  be  the 
crystalline  active 
principle  of  supra- 
renal glands). 

♦Adrenalin  chloride. 
♦Epinephrine      (al- 
kaloid       obtained 
from       suprarenal 
capsules). 

..Ether,  ethylic  ether, 
96%. 
Spiritus        ffitheris 

32.5%. 
Spiritus  _       aetheris 
compositus.   Hoff- 
man's anodyne. 
*^ther,  nitrous. 
Spiritus         setheris 
nitrosi,  sweet 

spirit  of  nitre. 
.Ethylis     chloridum, 
ethyl  chloride. 


♦Agaric,  spunk  (a 
fungus). 

Albolene.  See  Petro- 
latum. 

♦Albumin. 

Alcohol,  ethyl  alco- 
hol, 94.9%  by  vol. 


Absolutum,  99%. 
Dilutum,  48.9%. 
Spiritus     frumenti 

whiskey,  44-55%. 
Spiritus  vini  gallici, 

brandy,  46-55%. 
♦Alcohol,        methyl 

wood  alcohol. 


Aloe,    aloes    (inspis 
sated       juice       of 
leaves). 
Aloe  purificata. 
Extractum  aloes. 
Pilulae  aloes. 
Pilulae  a.  et  ferri. 
Tinctura. 
Aloinum,         aloin 
(from  aloes). 


Pilulse     laxativse 
compositae. 
Alumen,  alum, 
aluminum      and 
potass,  sulphate. 


Alumen  exsiccatum, 
dried  alum. 

Alumini  sulphas. 


N. 

N. 


N.t 


10 


al. 

N. 


N. 
N. 

N. 

N. 
N. 


si.  sol. 


sol. 
misc. 


sol.  in 
boiling 
water. 


insol. 


65 
V.  s.  in 
boiling 
water. 


sol. 


insol. 


17    insol. 
1     insol. 


J   Chiefly 
(.local  use 


m5-30 
foM-l 
foM-1 


local  use 


freely 


f51- 
fol- 


f51-8 


gr.    1-10 


gr.    1-10 
gr.    Ji-3 

1-4  pills 
1-4   pills 

fs  M-1 

gr.  ?^-2 


1-3  pills 
gr.    5-30 


local  use 
local  use. 


0.30-2 
1-4 


2-8 


4-30 
4-30 


4-30 


0.06-0.60 


0.06-0.60 
0.03-0.20 


1-4 
0.03-0.12 


0.30-2 


Uses. 


Lanolib  has  advan- 
tage of  being  able  to 
hold  an  aqueous  so- 
lution. 


Preparations  from  the 
adrenals  are  arterial 
stimulants  in.iected 
intravenously,  and 
hemostatics  locally. 
To  constrict  arteri- 
oles, solutions  of  ac- 
tive principle,  1 :  1000 
to  1:3000,  are  ap- 
phed.  The  chloride 
is  mostly  used. 
Anesthetic.  Local  irri- 
tant. Stimulant  by 
reflex  irritation.  The 
spirits  are  used  for 
stimulating  and  ano- 
dyne effects. 


Diuretic.  Diaphoretic. 
In  fevers  and  in 
nephritis. 

A  nesihetic.  A  nalgesic. 
Inhaled,  produces 
anesthesia  quickly 
and  safely. 

Absorbent.     Hemo- 
static. 


Demulcent.     Antidote. 

Solvent.  Preservative. 
Antiseptic.  Locally 
irritating  to  mucous 
membranes  accord- 
ing to  concentrajtion. 
Internally  stimulant 
but  in  large  doses  is 
sedative. 


Solvent.  Antiseptic. 
Not  used  internally. 
Fumes  have  caused 
blindness. 

Bitter  tonic.  Cathartic. 
Emmenagogue.  In 
habitual  constipa- 
tion. In  hemor- 
rhoids not  due  to 
active  congestion.  In 
amenorrhea,  anemia, 
chlorosis. 

Cathartic. 


i stringent.  Gargle  or 
wash.  _  To  check 
superficial  hemor- 
rhage. Large  dose 
emetic. 

Astringent.  Caustic. 
Applied  to  excessive 
granulations. 

Astringent.  Antiseptic. 


t  Spiritus  aetheris  nitrosi  easily  becomes  acid,  and  is  usually  so  a,s  found  in  the  stores, 


272 


INDEX  OF  DB  UGS 


Page 
ia 
text. 


Drug. 


Reac- 
tion. 


Solubility  in 


Water   Alcohol 


Dose. 


Gm.  or 
c.c. 


Uses. 


198 


73 


198 


Plate 

XV. 

199 


29 


203 

Plate 

xiii. 

265 


231 


106 
219 


54 


♦Ammonia,  a  gas. 
Aqua   ammonise,    a 

10%     solution     of 

the  gas  in  water. 
Aqua  ammoniae 

fortior,  28%. 
Linimentum. 
Spiritus    ammoniae, 

10%. 
Spiritus     amnionise 

aromaticus. 
Liquor         ammonii 

acetatis. 
Ammonii  benzoas. 
Ammonii       bromi- 

dum. 
Ammonii  carbonas. 


Ammonii        chlori- 

dum. 
Trochisci    ammonii 

chloridi. 
Ammonii  iodidum. 
♦Ointment,  10%. 
*Ammonii  nitras. 

Ammonii  valeras. 
Amygdala     amara, 

bitter  almond 

seeds. 
Aqua         amygdalae 

amarae. 
Oleum      amygdalae 

amarae. 
Spiritus. 
Amygdala     dulcis, 

sweet      almond 


amyg- 


Emulsum 

dalae. 
Syrupus. 
Oleum      amygdalae 

expressum. 
Amylis  nitris,  nitrite 

of  amyl. 

Amylum,  starch. 

Glyceritum  amyli. 
Anesthesin. 
Animal         charcoal. 

See  Carbo. 
Anisum,  anise  seed. 
Aqua  anisi. 
Oleum. 
Spiritus._ 
Antimonii   et  potas- 
sii    tartras,    tartar 
emetic. 
Vinum  antimonii. 

Antipyrina,  phena- 
zone. 

*Antiseptol,  cincho- 
nine  iodosulphate, 
50%  iodine  (a 
substitute  for  iodo- 
form). 

♦Antitoxin,  a  serum 
that  is  antidotal 
to  the  toxin  of  a 
certain  disease.  As 
an  example,  set 
Serum  antidiph- 
thericum. 


al. 

sol. 

sol. 

al. 

al. 

■  al.'  ■ 

al. 

ac. 

N. 

10.5 

25 

si.  ac. 

1.2 

12.5 

al. 

4 

t 

N. 

2 

50 

N. 

0.6 

9 

■  N.'  ■ 

"6.5 

"'26' 

ac. 

V.  s. 

V.  s. 

N. 

N. 

300 

sol. 

N. 

N. 

insol. 

misc. 

'  N.'  ■ 

N. 

1 

si.  ac. 

16 

insol. 

N. 

1 

1 

niio-30 


till  0-30 

f5M-l 

f5M-l 

gr.  5-20 
gr.  5-30 

gr.  2-15 

gr.  1-30 

1)4  gr.  in 
each 
gr.  2-10 


gr.  2-8 


fo2-4 
1715-10 


f3i-4 

mi-3 


freely 


gr.  10-30 

f5M-l 

nii-5 

f31-2 

gr.  }-^-2 

gr.  1/10-}^ 

rri5-60 

gr.  5-20 


0.60-2 


extern. 
0.60-2 


1-4 
8-30 


0.30-1.30 
0.30-2 


0.12-1 


0.06-2 


0.12-0.60 
extern. 


0.12-0.50 


8-15 
0.01-0.03 
0.30-.60 


•     4-15 
0.06-0.20 


0.60-2 

8-30 

0.06-0.30 

4-8 
0.03-0.12 
0.006-0.03 

0.30-4 

0.30-1.30 


Stimulant.  Inhaled  in 
syncope.     Solvent. 

Aq.  ammoniae  fortior 
is  caustic. 

Same  uses  as  aqua 
ammoniae. 

Diaphoretic  in  fevers. 

Same  as  benzoic  acid. 

Sedative.  In  epilepsy, 
whooping-cough. 

Stimulant.  Expecto- 
rant. In  pneumonia, 
typhoid  conditions. 

Expectorant  in  bron- 
chitis; alterative  in 
myalgia. 

Alterative  in  syphilis, 
scrofula. 

To  prepare  nitrous 
oxide. 

Stimulant  in  hysteria. 

Nerve  sedative  in 
cough,  vomiting. 
The  preparations  of 
bitter  almond  con- 
tain hydrocyanic  acid 
in  small  amount. 


As  vehicle. 

As  vehicle. 
Demulcent. 

Inhaled  in  angina 
pectoris,  asthma,  hic- 
cough, epilepsy. 

Demulcent.       Dusting 

powder. 
Demulcent. 
Local  analgesic. 


Aromatic  Carminative. 

In  colic. 
Flavoring  agent. 

Emetic. 

Sedative.  Expectorant. 

Depresses  heart. 
Expectorant. 

Antipyretic  in  acute 
fevers.  Anodyne  in 
neuralgias,  migraine, 
myalgia,  pertussis, 
infantile  convulsions. 
Hemostatic  locally  to 
check  capillary  hem- 
orrhages. 


t  Decomposition  occurs. 


INDEX  OF  DRUGS 


273 


Page 
in 

text. 


Drug. 


Plate 


Apomorphinse       hy- 
drochloridum 
(from  morphine). 

Aqua  hydrogenii  di- 
oxidi  (3%),  per- 
oxide of  hydro- 
gen, pyrozone,  10- 
volume  solution 
in  Yv^ater. 

♦Ethereal  solution  of 
hyd.  dioxide,  25%. 

*Argentum,  silver,  a 
metal. 
*Argenti  citras, 
itrol. 
*Argenti  lactas, 

actol. 
Argenti  nitras. 


Argenti    nitras    di- 
lutus,'  mitigated 
caustic,  333^%. 

Argenti  nitras 
fusus,  lunar  caus- 
tic. 96%. 

Argenti  oxidum. 
Aristol.  _     See  Thy- 

moUs  iodidum. 
*Armoracia,     horse- 
radish  (root). 
Arnica  (flowers). 

Tinctura  arnioae. 
Arseni        trioxidum, 
arsenic. 

Liquor  acidi  arsen- 
osi,  1  'A. 

Liquor      potassii 
arsenitis, 

Fowler's  sol.  _ 

Liquor     sodii 
arsenatis,  1  %. 

(Pearson's  sol.  ^/lo  as 
strong  as  above.) 

Liquor  arseni  et 
hydrargyri  iodidi 
Donovan's  solu- 
tion. _ 

♦Solution  of  potas- 
sium arsenate  and 
bromide,  Clemen's 
solution. 

Arseni  iodidum. 

Sodii  arsenas. 
Asafetida.      A  gum 
resin. 

Emulsum  asafetidae, 
milk  of  asafetida. 

PUulae  asafetidae. 

Tinctura. 
*Aseptol,    a   33  H% 
solution  of  ortho- 
phenolsulphonic 
acid. 
Aspidium,  male  fern 
(root). 
Oleoresina  aspidii. 
Atropina. 

Atropinae  sulphas. 
Homatropinae     hy- 

drobromidum. 

See  Belladonna. 


Reac- 
tion. 


N. 


si.  ac. 


N. 
N. 
N. 
al. 


si.  ac. 
ac. 

al. 

N. 


Solubility  in 


Water    Alcohol 


40 


si.  sol. 
20 


0.54 
sol. 


sol. 
si.  sol. 


{loo} 


N. 
N.oral. 


al. 


12 

1.2 
part. 


sol. 


450 


0.38 
5.7 


Dose. 


Gm.  or 
c.c. 


Uses. 


40 


24 
sol. 


sol. 
insol. 


si.  sol. 


28 
si.  sol. 
part. 


sol. 


3.7 
32.5 


18 


gr.  1/20-Vio 
local  use 

local  use 

extern, 
extern, 
gr.  H-1 


gr.  K-2 

3M-2 

Tni5-45 
gr.  Veo-^/lo 

ni2-io 

1112-10 

rn2-io 

1112-10 

ni2-io 


gr.  1/30-Vio 

gr.  Vso-Vio 

gr.  1-8 

3  gr.  in 

each. 
f3J^-l 


5J^-2 

f3M-l 
gr.  V120-V6O 

gr.  1/120-V6O 
gr.  1/120-^/20 


0.003-0.006 


0.015-0.06 


0.03-0.12 

1-8 

1-3 

0.001-0.006 

0.12-0.60 

0.12-0.60 
0.12-0.60 

0.12-0.60 

0.12-0.60 


0.002-0.006 

0.002-0.006 

0.06-0.50 

15-30 


2-4 


2-8 


1-4 
,0005-0.001 


.0005-0.001 
.0005-0.003 


Emetic.  Hypodermi- 
cally  when  patient 
cannot  swallow,  as 
in  opium  narcosis. 

Disinfectant.  To 
cleanse  ulcers  and 
wounds.  In  infec- 
tious diseases.  To 
cleanse  pulp  cham- 
bers and  canals. 

Caustic,  used  chiefly 
to  bleach  teeth. 

Silver  salts  are  astrin^ 
qent  and  antiseptic.  A 
form  of  metallic  sil- 
ver soluble  in  water, 
also  citrate  and  lac- 
tate are  used  as  anti- 
septics. Nitrate  as  as- 
tringent. In  chronic 
dysentery,  gastric 
ulcer,  diarrhea  of  ty- 
phoid fever.  To 
check  caries  in  tem- 
porary teeth.  Also 
as  caustic.  Locally  to 
abort   inflammation. 

In  nervous  diseases. 


Tonic.  In  indiges- 
tion, scurvy. 

As  a  Uniment. 

Escharotic.  Has  slow 
but  powerful  action. 
To  devitalise  pulps 
of  teeth.  In  small 
doses  alterative  tonic. 
To  improve  the  nu- 
trition in  anemia, 
chorea,  chronic  dis- 
eases of  the  skin. 
Antiperiodic  in  ma- 
larial fever. 

Donovan's  solution  as 
a  combination  of 
alteratives  is  used  in 
syphilitic  and  tuber- 
culous (scrofulous) 
conditions. 


Stimulant.  Laxative. 
As  antispasmodic  in 
hysteria,  chorea,  and 
other  nervous  spas- 
modic conditions.  In 
flatulent  coUc. 

Antiseptic.  Locally  in 
dilute  solution. 


Anthelmintic.  To  de- 
stroy tapeworm. 

Stimulant.  Mydriatic. 
To  dilate  pupil  and 
paralyze  accommo- 
dation. To  relieve 
peripheral  irritation, 
cough,  asthma,  etc. 
As  respiratory  stim- 
ulant in  opium  poi- 
soning. Homatropine 
is  a  more  transient 
mydriatic. 


274 


INDEX  OF  DRUGS 


Solubility  in 

Dose. 

Page 

Drug. 

Reac- 

in 

Gm.  or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

Aurantii  amari  cor- 

Bitter tonic.     Carmin- 

tex, bitter  orange- 

ative.     Preparations 

peel. 

used        chiefly       as 

Fluidext  ract  um 

iZ}4-l 

2-4 

vehicles. 

aurantii  amari. 

Tinotura. 

f5i-2 

4-8 

Aurantii  dulcis 

Preparations    as    fla- 

cortex,  sweet 

voring     agents     and 

orange-peel. 

vehicles. 

Oleum  aurantii 

N. 

insol. 

4 

Flavoring  agent. 

corticis. 

Syrupus  aurantii. 

1 

Spiritus  a.  comp. 

I 

freely 

As  vehicles. 

Tinctura  a.  dulcis. 

♦Aurantii  flores, 

orange  flowers. 
Aqua  a.  floruni. 

Flavoring  agents. 

Aqua  a.  fl.  fortior. 

SjTupus  a.  florum. 

As  vehicle. 

*01euni  a.  florum. 

'  N."  ■ 

insol. 

"i" 

Perfume. 

oil  of  neroU. 

*Aurum,  gold. 

Auri     et     sodii 

si.  ac. 

V.  s. 

part. 

gr.  Vso-Vio 

0.002-0.006 

Alterative.      In    syph- 

chloridum. 

ilis,     action     similar 

*Aurum   bromide. 

gr.  Vioo-^/io 

0.0006-.006 

to  bichloride  of  mer- 

*Aurum chloride. 

sol. 

sol. 

gr.  '/eo-Vso 

0.001-0.002 

cury.       In     sclerosis 

♦Solution     of    gold 

m5-i5 

0.30-1 

of  liver  and  kidneys, 

and    arsenic    bro- 

impotence,   amenor- 

mide,     '  'arsenau- 

rhea,  nervous  disor- 

ro." 

ders,  diabetes.     The 

♦Solution    of    gold. 

ms-is 

0.30-1 

bromide  in  epilepsy. 

arsenic,   and   mer- 

The chloride  recom- 

cury bromide. 

mended  in  tubercu- 

"mercauro." 

lous  disorders. 

Balsam  of  copaiba. 

See  Copaiba. 

Balsamum   Permd- 

ac. 

5 

extern. 

In  scabies. 

anum. 

Balsamum  toluta- 

ac. 

sol. 

niio-30 

0.60-2 

Stimulant  expectorant. 

num. 

Syrupus  tolutanus. 

f  5  y2-i 

15-30 

As  vehicle. 

Tinctura  tolutana. 

fol-2 

4-8 

As  vehicle. 

Basham's     mixture. 

See  under  Ferrum. 

Bearberry.    See  Uva 

ursi. 

201 

Plate 

Belladonnse   folia, 
deadly  night- 

gr. 1-3 

0.06-0.20 

Mydriatic.  Atropine 
to  dilate  pupil. 

ix. 

shade  (leaves). 

262 

Extractum       bella- 

donnae  fohorum. 
Emplastrum. 

gr.  Va-H 
extern. 

0.0075-0.03 

Anodyne.  To  quiet 
peripheral  pain  and 
irritation;  in  a.sthma, 

Tinctura     _     bella- 

TT15-15 

0.30-1 

nervous   cough,   irri- 

donna foliorum. 

table  bladder,  incon- 

Unguentum    bella- 

extern. 

tinence      of      urine; 

donna. 

combined    with    ca- 

Belladonnse     radix 

gr.  1.-2 

0.06-0.12 

thartics    to    prevent 

(root). 

griping.         In   small 

Fluidext  ract  um 

nii-2 

0.06-0.12 

doses     stimulant     to 

belladonnas  radicis 

the  heart  and  respi- 

Linimentum   bella- 

e.xtern. 

ration.        In     opium. 

donnae. 

poisoning.           Vaao- 

See  Atropine. 

motor  stimulant.  To 
check  sweating. 

Benzinum  (from 

N. 

insol. 

6 

Solvent. 

petroleum). 

128 

Benzoinum. 

To     prepare     benzoic 

Tinctura  benzoini. 

'f'sJ^-i" 

2-4 

acid.     Antiseptic. 

Tinctura      benzoini 

f3}^-i 

2-4 

Tinctures  inhaled  in 

composita.  Friar's 

respiratory    diseases 

balsam. 

and  applied  as  local 
stimulants  and  anti- 
septics to  mucous 
membranes. 

♦Benzol  (from  coal- 

sol. 

Solvent. 

tar). 

♦Benzosol,    guaiacol 

insol. 

gr.  2-10 

0.12-0.60 

Antiseptia.     In  intes- 

benzoate. 

tinal  diseases  and 
phthisis, 

INDEX  OF  DRUGS 


275 


Page 


256 


122 


80 
136 


230 


Drug. 


165 

201 

Plate 


205 


See 
pruni 


Benzosulphinidum, 
saccharine  (a  coal- 
tar  product). 
Betanaphtol,naphtol 
♦Bismuth.    A  metal. 
Bismuthi       subcar- 

bonas. 
Bism.uthi  subnitras. 

*Bismuth  oxyiodide 

(subiodide). 
Bismuthi  subgallas 

dermatol. 
Bisulphide     of     car- 
bon.   See  Carbonei 

disulphidum. 
Bitter  almond.     See 

Amygdala   amara. 
Bitter  orange-peel. 

See  Aurantii. 
Blackberry.     See 

Rubus. 
Black  haw. 

Viburnum 

folium. 
Black  wash, 
Blue  ointment. 
Blue  pill.    See  under 

Hydrargyrum.  __ 
Borax.     See  Sodii 

boras. 
Glyceritum  boro- 

gl.ycerini,     31% 

boric  acid. 
Brandy.     See  under 

Alcohol. 
Bromoformum. 

Bromum,  bromine. 

Brown  mixture. 

See  under  Glycyr- 

rhiza. 
Buchu   (leaves). 
Fluidextractum 

buchu. 
Buckthorn.     See 

Frangula. 
Cacao    butter.      See 

under  Theobroma 
*Cactus  grandiflorus 

(cereus  g.). 
*Fluid  extract, 
*Tincture. 
*Ca£fea  (C.  arabica), 

coffee  (.seeds) 
Caffeina,         caffeine 

(theine). 
Caffeina  citrata,  50% 

caffeine. 
Caffeina    citrata    ef- 

fervescens,       2% 

caffeine. 
Cajuput,  oil  of.    See 

Oleum  cajuputi. 
Calamus,   sweet  flag 

(root). 
Fluidextractum 

calami. 
Calcium.     See  under 

Calx. 
Calomel.     See  under 

Hydrargyrum. 
Calumba  (.Tateo 

rhiza        palmata) 

columbo   (root). 
Fluidextractum 

calumbae. 
,  Tinctura. 


Reac- 
tion. 


Solubility  in 


Water    Alcohol 


N. 


si.  ac. 


N. 


250 

950 
insol. 
insol. 
insol. 
insol. 


300 

28 


45.6 
sol. 
sol. 


25 

0.6 

insol. 
insol. 
insol. 
insol. 


sol. 
sol. 


53.2 

sol. 
sol. 


Dose. 


Gm.  or 
c.c. 


gr.    1-8 

gr.  2-10 
gr.  5-60 
gr.  5-60 
gr.  5-10 
gr.  5-15 


extern. 


gr.  15-30 
TT115-30 


nii-5 

ni5-20 


gr.   1-5 

gr.  2-10 

31-8 

gr.   15-60 
nil5-60 


gr.  5-30 

ni5-30 
fa  1-4 


0.06-0.50 

0.12-0.60 

0.30-4 

0.30-4 

0.30-0.60 

0.30-1 


0.06-0.30 


1-2 

1-2 


0.06-0.30 
0.30-1.20 


0.06-0.30 
0.12-0.60 
4-30 


Sweetening  agent. 
Is  280  times  sweeter 
than  cane-sugar. 

Antiseptic. 

Locally  sedative  and 
slightly  astringent. 
In  vomiting,  cUar- 
rhea,  gastric  ulcer. 

Antiseptic  to  dress 
wounds    and    ulcers. 

A  ntiseptic.  As  substi- 
tute for  iodoform; 
also  internally. 


Uses. 


-intiseptic. 


Anesthetic.        Recom- 
mended in  pertussis. 

Caustic.     Reagent. 
Antiseptic. 


Stimulant  diuretic  in 
chronic  inflamriiation 
of  the  genitourinary 
tract. 


Heart  tonic.  In  action 
similar  to  digitahs. 

Stimulant.  Diuretic. 
Stimulates  cerebrum 
and  heart.  In  opium 
poisoning  strong  in- 
fusion or  decoction 
by  enema  or  caffeine 
hypodermicaUy.  In 
headaches,  cardiac 
failure. 


1-4        Aromatic  stimulant. 

In  indigestion. 
1-4 


0.30-2 

0.30-2 
4-15 


Bitter  tonic.  In  atonic 
indigestion.  It  con- 
tains no  tannin^ 


276 


INDEX  OF  DRUGS 


Solubility  in 

Dose. 

Page 
in 

Drug. 

Reac- 

Gm. or 

Uses. 

text. 

tion. 

Water 

Alcohol 

c.c. 

Calx,  Ume. 

al. 

760 

insol. 

Caustic. 

136 

Calx         chlorinata, 

al. 

part. 

part. 

■gr.'2-5' 

6.'l'2-0.36 

Disinfectant. 

151 

bleaching  powder, 
chloride  of  Ume. 

Calx  sulphurata 

al. 

si.  sol. 

insol. 

gr.  Vio-l 

0.006-0.06 

To   prevent   suppura- 
tion. 
Externally    to    burns 

90 

Linimentum  calcis. 

carron  oil. 

and  scalds. 

116 

Liquor  calcis,  lime- 
water. 

al. 

fol-8 

4-30 

Alkali.  In  vomiting, 
diarrhea.        To    cor- 

*Potassa cum  calce. 

al. 

extern. 

rect  acidity  and  irri- 

Viennae     paste,    a 

tabihty  of  stomach. 

caustic. 

Syrupus  calcis. 

al. 

nil5-60 

1-4 

Antidote      to     oxalic 

♦Calcium,   a  metal. 

acid. 

Calcii  bromidum. 

N. 

0.5 

1 

gr.   15-30 

1-2 

Sedative.  Same  use  as 
potassium  bromide. 

■  Calcii    carbonas 

] 

Preparations     of    the 

6 

praecipitatus. 

aim. 
insol. 

carbonate    are    used 

117 

d 

Cretae   praepa- 

■al. 

insol. 

gr.  5-60 

0.30-4  ■ 

in  indigestion,  vom- 

G 

rata,    prepared 

iting,    and   diarrhea. 

O  ■ 
SI 

chalk. 

Prepared     chalk     as 

t 

Mistura  cretae. 

, 

fo2-4 

8-15 

an    antacid    to    the 

O 

Pulvis  cretae 
compositus. 

gr.  6-60 

0.30-4 

mouth  and  in  denti- 
frices. 

109 

Calcii  chloridum. 

N. 

1.3 

8 

gr.  5-10 

0.30-0.60 

A  Iterative.  Hemo- 
static. Internally  in 
hemorrhagic  dia- 
thesis. 

Calcii  hypophosphis. 

N 

6.5 

insol. 

gr.  2-5 

0.12-0.30 

Tonic.  Alterative.  In 
anemia,        rhachitis, 

*Syrup. 

f3l-2 

4-8 

caries. 

210 

Syrupus  hypo- 
phosphitum. 

f3i-2 

4-8 

Syrups  of  hypophos- 
phites     in      wasting 

210 

Syrupus  hypo- 
phosphitum    com- 
positus. 

f5l-2 

4-8 

diseases,  tuberculo- 
sis, rhachitis,  ner- 
vous diseases. 

Calcii  phosphas 

aim. 

insol. 

gr.  5-30 

0.30-2 

Similar  uses  to  above. 

praecipitatus. 

insol. 

Syrupus   calcii   lac- 



fol-2 

4-8 

Similar  uses  to  above. 

tophosphatis. 

Calcii     sulphas     ex- 

N. 

378 

insol. 

Used   in   making   im- 

siccatus,      plaster 

pressions,  casts,  and 

of  Paris. 

plaster-of-Paris  ban- 
dages and  jackets. 

*Calcium  iodide. 

0.5 

gr.  2-4 

0.12-0.25 

Alterative.  Antiseptic. 
In  pulmonary  syph- 
ilis. 

Cathartic.        In  drop- 

Cambogia, Gam- 

gr.  1-3 

0.06-0.20 

boge. 

sies. 

199 

Camphora,  cam- 

si. sol. 

sol. 

gr.  3-10 

0.20-0.60 

Stimulant.     Anodyne. 

263 

phor. 

To  reUeve  spasm  or 

Aqua  camphorae. 

f§J^-2 

15-60 

cramp,       dysmenor- 

Ceratum. 

extern. 

rhea,    cholera,  colic, 

200 

Spiritus,  10%. 

Linimentum     cam- 
phorae,    camphor- 
ated oil,  20%. 

■f3J^-i' 

2-4 

diarrhea,  nervous  de- 
pression, headache, 
neuralgia.  Spirit  in- 
haled in  syncope. 
Liniment  externally. 

*Acid          camphor 

fol-4 

4-15 

In  diarrhea. 

mixture,     Hope's 

mixture. 

♦Volatile   oil   of 
camphor. 
Camphora  mono- 

tni-3 

0.06-0.20 

Stimulant. 

N. 

aim. 

sol. 

gr.  2-10 

0.12-0.60 

Monobromate  is  seda- 

bromata. 

insol. 

tive  to   nervous  sys- 

Canada balsam. 

tem.       In    insomnia 

See  Terebinthina 

and  hysteria. 

Canadensis. 

263 

Cannabis  indica   (C. 
sativa,     grown    in 
E.  Indies),  Indian 
hemp.        (Tops  of 
female  plant.) 

gr.  2-5 

0.12-0.30 

A  nodyne.  Deliriant. 
Hypnotic.  In  mi- 
graine, neuralgia, 
dysmenorrhea,  irri- 
table bladder,  reten- 

Extractum   canna- 

gr. K-H 

0.01-0.03 

tion   of   urine.         In 

bis  indicae. 

tetanus,         delirium 

Fluidextractum. 

ni2-5 

0.12-0.30 

tremens,    acute   ma- 

Ti 

nctura. 

m5-30 

0.30-2 

nia. 

INDEX  OF  DRUGS 


277 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Water   Alcohol 


Gm.  or 

CO. 


Uses. 


67 
263 


61 


145 


145 


133 


Cantharis,      Spanish 

flies. 
Ceratum     canthar- 

idis. 
Collodium  canthar 

idatum. 


Tinctura 
idis. 


canthar 


Capsicum    (C.    fas- 
tigiatum) ,     Cay- 
enne pepper 
(fruit). 
Fluidextractum 

capsici. 
Emplastrum. 
Oleoresina. 
Tinctura. 
Caraway.  See  Carum 
Carbo  animalis, 
animal  charcoal 
Carbo  animalis 
purificatus. 


Carbo     ligni, 
charcoal. 


wood 


Carbonei  disul- 
phidum. 

Cardamomum 

(elettaria  repens), 
cardamom  (fruit). 
Tinctura  carda- 

momi. 
Tinctura  c.  comp. 

*Carmine,  carminic 
acid  (from  coc- 
cus). 

Carron  oil.  See  un- 
der Calx. 

Carum      (c.     carvi) , 
caraway  (seed). 
Oleum  cari. 

Caryophyllus    (euge- 

nia        aromatica) 

cloves  (flower 

buds). 

Oleum  caryophylli 

Cascara  sagrada.  See 
Rhamnus. 

Cassia,  oil  of.  (com 
mercial  oil  of  cin 
namon). 

Castor  oil.     See 
Oleum  ricini. 

Catechu.     See 
Gambir. 

*CeUuloid,  zylonite. 


Cera  alba,  white 
wax. 
Ceratum. 

Cera     flava,   yellow 
wax. 

Cetaceum,     sperma- 
ceti. 

Chalk,  prepared.  See 
under  Calcium. 

Charcoal.  (See  Carbo. 


526 


sol. 


insol. 


insol. 

insol. 

insol. 
insol. 


sol. 


insol. 


aim. 
insol. 


rrii-5 


gr.  1-3 


WA-2 


TTlM-l 
1115-10 


freely 


gr.  10-15 

f5l-2 
f:^2-4 


gr.  15-30 

nii-5 

gr.  2-15 


mi-5 


0.06-0.30 


0.06-0.20 


0.03-0.12 

extern. 
0.015-0.06 
0.30-0.60 


0.60-1 

4-8 
8-15 


1-2 


0.06-0.30 
0.12-1 


0.06-0.30 


Vesicant.  To  produce 
blister  in  neuralgia, 
rheumatism;  coun- 
teract local  inflam- 
mations; promote 
absorption  of  effu- 
sions. 

Tincture  internally  is 
diuretic  and  irritant. 
Use  cautiously.  Ap- 
plied locally  diluted, 
stimulates  growth  of 
hair.  In  alopecia 
areata. 

Local  stimulant  and 
irritant.  To  stimu- 
late unhealthy  con- 
dition of  the  gums. 
In  atony  of  stomach, 
diarrhea,  colic,  indi- 
gestion of  alcohol- 
ism. Plaster  as  mild 
oounterirritant. 

Decolorizing  agent. 

As  antidote  in  alka- 
loidal  poisoning.  To 
decolorize  and  purify 
liquids. 

Absorbent.  Internally 
in  flatulent  indiges- 
tion. 

Solvent  for  rubber. 

Aromatic.  As  flavor- 
ing agent  and  car- 
minative. In  flatu- 
lent coUc. 


Coloring  agent. 


Arom,atic.  As  condi- 
ment and  carmina- 
tive. 

Aromatic.  As  condi- 
ment and  carmina- 
tive. The  oil  in  pre- 
paring microscopic 
specimens. 


Non-medicinal.     In 
making  trusses, 
plates    for    artificial 
teeth,  etc. 

In  cerates  and  oint- 
ments. As  impres- 
sion and  modelling 
material. 

In  cerates  and  oint- 
ments. 


278 


INDEX  OF  DRUGS 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Water    Alcohol 


Gm.  or 
c.c. 


Uses. 


225 

Plate 

xvi. 

263 


Chloralum  hydratum 


136 
151 


136 


136 


186 
Plate 
vii. 
68 

263 


80 
206 


137 


*Butyl-chloral,    cro- 
ton-chloral. 


*Chloral-camphor, 
*Chloral-phenoI. 
*Chloral-menthol. 
Chloral  formami- 
dum,  chloralamid 


*Chloretone,  acetone- 
chloroform. 
Chloride  of  lime.   See 

Calx  chlorinata. 
♦Chlorine.     A  gas. 
Liquor  chlori  com- 

positus,  0.4%. 
Liquor    sod«    chlo 
rinatffi,   Labar- 
raque's      .solution, 
2.4%  chlorine. 
Calx  chlorinata, 
chloride    of    lime, 
30%  chlorine. 
Chloroformum. 
Aqua  chloroformi, 
0.5%. 

Emulsum,  4%. 

Linimentum,  30%. 

Spiritus,  6%. 

A    stronger    spirit 

(K  chloroform)  is 

known  as  chloric 

ether. 

Chromii     trioxidum, 

chromic  acid. 
Cinchona,  Peruvian 

bark. 
Cinchona  rubra. 
Fluidextractum 

cinchonae. 
Tinctura. 

Tinctura  cinchonse 
composita. 
See  Quinina. 
Cinchonidinse    sul- 
phas. 


Cinchoninae  sul- 
phas. 

*Cinchonine  iodo- 
phate,  antiseptol. 

Cinnamomum  saigo- 
nicum,  saigon  cin- 
namon (bark). 


sol. 

sol. 

insol. 
sol. 

'18.7" 

sol. 
sol. 
sol. 
1.3 

125 

V.  s. 

part. 

part. 

200 

sol. 

V.  s. 

t 

63 

72 

58 
insol. 

10 

gr.  5-20 


gr.  5-20 


>  extern, 
gr.  10-30 

gr.  5-15 

f5i-4 
f3J^-l 


Tn2-10 
f5?4-i 


f31-4 
'fo^-2" 


gr.  10-60 


gr.  10-60 
TTllO-60 


3J^-2 
f3l-4 


gr.  1-30 


gr.  1-30 

extern. 


0.30-1.30 


0.30-1.30 


0.60-2 


0.30-1 


4-15 

2-4 


0.12-0.60 
8-30 


4-15 
extern. 

2-8 


0.60-4 


0.60-4 
0.60-4 


2-8 
4-15 


0.06-2 


0.06-2 


Hypnotic.  Sedative. 
In  insomnia,  mania, 
tetanus,  convubions 
of  children,  strych- 
nine poisoning,  epi- 
lepsy, other  spas- 
modic affections, 
delirium  of  fevers, 
cholera,  and  cholera 
morbus.  Use  cau- 
tiously when  heart 
is  weak. 

Croton-chloral,  simi- 
lar to  chloral  in  ac- 
tion, is  said  to  have 
a  special  anodyne 
effect  upon  the  fifth 
cranial  nerve. 

Locally  in  neuralgia 
as  anodyne  and  coun- 
terirritant. 

Hypnotic.  Safer  than 
chloral.  In  insomnia 
of  fevers,  whooping- 
cough,  asthma,  and 
other  spasmodic  af- 
fections. 

Hypnotic.    Analgesic. 


Antiseptic.  Externally 
to  foul  ulcers  and 
as  disinfectant  wash. 
Bleaching  agent.  To 
bleach  discolored 
teeth. 

Disinfectant.  Bleach- 
ing agent. 

Anesthetic.  Anodyne. 
By  inhalation  most- 
ly. In  convulsions, 
dysmenorrhea,  and 
other  spasmodic 
pain.  Locally    as 

anodyne  and  irritant. 
Internally  in  coUc. 


Caustic.  Local  use 
only. 

Bitter  astringent  tonic. 
In  atonic  indiges- 
tion, relaxed  condi- 
tions of  mucous 
membrane  of  diges- 
tive tract;  general 
tonic.  A  ntiperiodic. 
In  malarial  fevers, 
periodic    neuralgia. 

The  alkaloids  possess 
the    tonic    and    anti- 
malarial   virtues    of 
cinchona.     In   medi- 
cinal     value      they 
stand  in   the  follow- 
ing  order: 
Quinine. 
Cinchonidine. 
Cinchonine. 

Antiseptic.  An  odor- 
less substitute  for 
iodoform. 


t  Decomposition  occurs. 


INDEX  OF  DRUGS 


279 


Solubility  in 

Dose. 

Page 
in 

Drug. 

Reac- 

Gm. or 

Uses. 

text. 

tion. 

Water 

Alcohol 

c.c. 

Cinnamomum      zey- 

Aromatic,  Condiment. 

lanicum,      Ceylon 

cinnamon  (bark). 

Aqua  cinnamomi. 

fBJ^-1 

15-30 

As  vehicle. 

132 

Oleum   cinnamomi. 

si.  ac. 

insol. 

sol. 

rni-s 

0.06-0.30 

Flavoring  agent.  Used 

Spiritus. 

rnio-30 

0.60-2 

as     carminative     in 

Tinctura. 

f3i-2 

4-8 

flatulence.     Antisep- 

Clemen's      solution. 

tic.     Spirit  and  tinc- 

See   under   Arseni 

ture  as  vehicle. 

trioxid. 

("  Oil    of   Cassia "    is 

Cloves.     See  Caryo- 

oil  of  Chinese  cinna- 

rhyUus. 

mon.) 

88 

♦Cobalt. 

extern. 

Escharotic.  To  devi- 
talize pulps  of  teeth. 

158 

Coca,     erythroxylon 

oK-l 

1-4 

Stimulant.     In  action 

200 

coca  (leaves). 

similar  to  cofiee.     In 

Plates 

riuidextractum 

f3M-l 

1-4 

debihty  of  old  peo- 

ii, iii. 

cocse. 

ple.         Large    doses 

Vinum. 

f3l-4 

4-15 

are  sedative.    Locally 

Cocaine  (from  sev- 

" al.'  ■ 

'eoo' 

■■5" 

depresses    sensation. 

eral     varieties     of 

To  relieve  vomiting. 

coca). 

The  alkaloid  cocaine 

158 

Cocainae    hydrochlo- 

N. 

0.4 

2.6 

gr.  ye-'A 

0.01-0.03 

is   a   local   analgesic. 

Plates 

ridum. 

stimulant,  and   myd- 

ii, iii. 

Oleatum  cocainse, 

5%-           ,  .       , 
Coccus,    cochineal 

(an  insect).     Used 

as  coloring  agent. 

See  also  Carmine. 

locally 

riatic.  Locally  or 
hypodermically  in  1 
to  4%  aqueous  solu- 
tion to  aboUsh  sen- 
sation. In  supposi- 
tory to  relieve  tenes- 
mus in  dysentery. 
Applied  to  the  eye 
it  dilates  pupil.  Use 
cautiously  to  avoid 
poisoning  or  habit. 

227 

Codeina   (alkaloid 

N. 

88 

1.6 

gr.  M-1 

0.015-0.06 

Same    use    as   opium. 

265 

from  opium). 

The  after-effects  are 

Codeinae  phosphas. 

ac. 

2.25 

261 

gr.  M-1 

0.015-0.06 

less  unpleasant.     In 

Codeinee  sulphas. 

N. 

23 

1035 

gr.  M-1 

0.015-0.06 

diabetes. 

• 

Cod-liver    oil.       See 

Oleum  morrhuae. 

Coffee.    See  Caffea. 

216 

Colchici            cormus 
(corm    of     colchi- 
cum  autumnale). 

gr.  2-10 

0.12-0.60 

Colchicum  is  a  vege- 
table alterative.  In 
full     doses     diuretic 

Extractum  colchici 

gr.  J^-2 

0.03-0.12 

and     cathartic.       Its 

cormi. 

chief  use  is  in  sub- 

Colchici semen 

gr.  1-5 

0.06-0.30 

acute      or      chronic 

(seed). 

rheumatism   and    in 

Fluidextracturn 

rTii-5 

0.06-0.30 

rheumatic  gout.     In 

colchici  seminis. 

ascites    due    to    he- 

Tinctura colchici 

TniO-60 

0.60-4 

patic   obstruction. 

seminis. 

Colchicine    may_  be 

Vinum  colchici 

TTllO-60 

0.60-4 

given  hypodermi- 

seminis. 

cally. 

Colchicina  (alkaloid 

N. 

22 

V.  s. 

gr.  Vioo 

0.006 

from  c. autumnale) 

Cold  cream.     See 

under  Rosa. 

111 

Collodium,  collo- 
dion. 

extern. 

Protective  to  slight 
wounds  and  to  check 

111 

Collodium        flexile, 
flexible  collodion. 

superficial  hemor- 
rhages. 

67 

Collodium     canthar- 
idatum. 

extern. 

Vesicant.  For  bhster- 
ing  purposes. 

111 

Collodium        stypti- 
cum,   20%    tannic 
acid. 

extern. 

Styptic. 

Plate 

Colocynthis     (citrul- 

gr.  1-3 

0.06-0.20 

Tonic     cathartic.      In 

xviii. 

lus  c,  fruit). 

constipation.  In  fuU 

Extractum      colo- 

gr.  M-1 

0.015-0.06 

doses    powerful    hy- 

cynthidis. 

dragogue       cathartic. 

Extractum  c.  com- 

gr.  5-15 

0.30-1 

In  dropsies.      Given 

positum. 

usually  in  combina- 

Pilulae   catharticae 

1-3  pills 

tion. 

compositae.t 

Pilulae    catharticae 

1-5  pills 

vegetables. 

Columbo.     See  Ca- 

lumba. 

t  1  grain  of  calomel  in  each. 


280 


INDEX  OF  DRUGS 


Solubility  in 

Dose. 

Page 
in 

Drug. 

Reac- 

Gm. or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

Convallaria    (c.    ma- 

gr.  5-30 

0.30-2 

Heart  stimulant.   Diu- 

jalis).   lily    of    the 

retic.          Similar  _  to 

valley   (root). 

digitalis    in     action. 

Flnidextractum 

rn5-3o 

0.30-2 

but  safer.     In  large 

convallarise. 

doses  cathartic. 

Copaiba,  balsam  of 

f3M-l 

1-4 

Diuretic.  Expectorant. 

copaiba. 

In     later    stages    of 

Oleum  copaibae. 

Tri5-15 

0.30-1 

gonorrhea;      chronic 

Copperas.    See  Ferri 

cystitis,  and  chronic 

sulphas. 

bronchitis. 

Copper  salts.     See 

under  Cuprum. 

Corrosive  sublimate. 

See  under  Hydrar- 

gyrum. 

Cotton.    See  Gossyp- 

ium. 

Cotton-seed  oil.  _  See 

under  Gossypium. 

Cream  of  tartar.   See 

Potassii  bitartras. 

67 

Creosotum   (distilled 

N. 

140 

sol. 

mi-5 

0.06-0.30 

Antiseptic.        Locally 

125 

from  wood.) 

sedative.    In  aqueous 

Aqua  creosoti,  1  %. 

f3l-4 

4-15 

solution    as    mouth- 

126 

Guaiacol. 

"53' 

sol. 

Tn2-10 

0.12-0.60 

wash.        To      check 

Guaiacolis  carbo- 

insol. 

48 

gr.  5-30 

0.30-2 

fermentation   within 

nas. 

the  digestive  tract. 
In  vomiting,  flatu- 
lence, and  fermenta- 
tive diarrhea.  Inter- 
nallyand  as  inhala- 
tion in  phthisis  and 
other  pulmonary  dis- 
eases. Guaiacol  and 
its  salts  used  for 
same  purposes. 

*Creolin    (from   coal 

misc. 

sol. 

mi-s 

0.06-0.30 

Antiseptic.     Valuable 

tar). 

for  general  use  as 
douche;  in  cystitis, 
intestinal    disorders.' 

Cresol. 

60 

misc. 

WA-2 

0.03-0.12 

Antiseptic. 

Creta  praeparata.  See 

under  Calcium. 

Croton  oil.      See 

Oleum  tiglii. 

91 

Cubeba     (Piper     c., 

3J^-l 

2-4 

Aromatic.      Stimulant 

230 

unripe  fruit). 

diuretic.         Expecto- 

232 

Fl  uidextractum 
cubebae. 

foH-1 

2-4 

rant.  In  bronchitis, 
pharyngitis    and 

Oleoresina. 

Tri5-15 

0.30-1 

laryngitis;       chronic 

Oleuni. 

TTl  5-20 

0.30-1.20 

inflammations     of 

Trochisci. 

gr.  M  of 
oleoresin 
in  each. 

genitourinary    tract. 

80 

*Cuprum,  copper. 

104 

Cupri  sulphas. 

ac. 

2.2 

400 

gr.  Vio-15 

0.006-1 

In    full    dose    em,etic; 

263 

*Cuprum  arsenite._ 

*Daturine    (alkaloid 
from  stramonium, 
probably      identi- 
cal with  atropine. 

Deadly    nightshade. 
See  Belladonna. 

Dermatol.  See  under 
Bismuthum. 

Diachylon  ointment. 
See     under  Plum- 
bum. 

si.  sol. 

gr.  Viao-Veo 

0.0005-.001 

locally  astringent 
and  irritant.  To 
stimulate  indolent 
ulcers.  As  a  mild 
caustic  applied  to 
granular  eyelids.  The 
arsenite  in  anemia, 
nervous  disorders, 
and  diarrheas. 

202 

DigitaHs    (d.    pur- 

gr. J^-3 

0.03-0.20 

Heart    stimulant    and 

Plate 

purea,  leaves). 

tonic.  Vasoconstrictor. 

xii. 

Extractum   digi- 

gr.  ^-1 

0.015-0.06 

Diuretic.  Strengthens 

229 

tali.s. 

and      slows       heart 

Flnidextractum. 

mH-3 

0.03-0.20 

beats.     In  weak  cir- 

Tnfusum. 

f3l-4 

4-15 

culation  due  to  heart 

Tinctura. 

tTl5-30 

0.30-2 

dilatation  or  ex- 
haustion. 

♦Digitalin. 

gr.  Veo-Vso 

0.001-.002 

A  product  of  uncer- 
tain and  variable 
character. 

INDEX  OF  DRUGS 


281 


Solubility  in 

Dose. 

Page 

Drug. 

Reac- 

in 

Gm.  or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

Diuretin.    See  under 

Theobroma. 

Dobell's  solution. 

See   under    Sodii 

boras. 

Donovan's  solution. 

See  under  Arseni 

trioxid. 

Dover's  powder.  See 

under  Opium. 

Elastica,    India-rub- 

In  making  bandages 

ber,  caoutchouc. 

and  various  surgical 
and     dental     appli- 

Plate 

ances. 

xviii. 

Elaterinum  (from 

N. 

insol. 

262 

gr.  ■';oo-'/i2 

0.003-.005 

Hydragogue  cathartic. 

264 

elaterium). 

In  dropsies,  cerebral 

Trituratio  elater- 

gr.  M-1 

0.03-0.06 

hyperemia  threaten- 

ini, 10%. 

ing  apoplexy. 

*Emetine     (alkaloid 

si.  sol. 

sol. 

gr.  1/120-V40 

0.0005  to 

Emetic.    May  be  used 

of  ipecacuanha). 

0.0015 

hypodermicaUy. 

*Eosin. 

sol. 

gr.  Vs-H 

0.0075  to 
0.015 

Coloring  agent. 

Epsom  salt.    See 

Magnesii  sulphas. 

108 

Ergota,  ergot  of  rye. 

Oxytocic.         Vasocon- 

Plate 

Extractum  ergotse, 

■gV.  5-15 

"36-i"' 

strictor.      To    stimu- 

i. 

'  'ergotin." 

late    contraction    of 

Fluidextractum. 

f3M-l 

1-4 

uterus     after     labor. 

Vinum. 

f3l-4 

4-15 

To  check  capillary 
hemorrhages,  menor- 
rhagia,  diarrheas. 
To    reduce    cerebral 

Eriodictyon,  yerba 

and     spinal     hyper- 

santa (e.  caUforni- 

emia. 

cum,  leaves). 

Stimulant  expectorant. 

Fluidextractum 

'rfll5-30 

■■■i-2'" 

In     chronic     pulmo- 

eriodictyi. 

nary    diseases.        In 

Eserine.      See  under 

syrup  to  cover  bitter 

Physostigma. 

taste  of  quinine. 

Ether,    chloric.     See 

under  Chloroform. 

Ether,  ethyUc.     See 

^ther. 

192 

*Ethyl  bromide,  hy- 
drobromic  ether. 

Ethyl  chloride.     See 
yEthylis         chlor- 
idum. 

spar. 

sol. 

inhaled 

Anesthetic.  Prompt 
in  action,  but  dan- 
gerous. 

*Ethyl    iodide,    hy- 

insol. 

sol. 

inhaled 

A  nesthetic.   A  Iterative. 

drioic  ether. 

Stimulant. 

♦Ethylene  bichlo- 

inhaled 

A  nesthetic.     Probably 

ride,  Dutch  Uquid. 

ranks  between  ether 
and     chloroform     in 

safety. 
Anesthetic.     Probably 

*Ethylidene  chlo- 

inhaled 

ride. 

less  depressing  than 
chloroform. 

169 

*Eucaine  hydro- 
chloride. 

Eucalyptus  (e.  globu- 
lus, leaves). 

N. 

28 

Local  analgesic.  Less 
powerful  and  toxic, 
but  more  irritating, 
than  cocaine. 

Formerly  in  malarial 

Fluidextractum 

'f3K-2' 

■■■2-8" 

fevers.      00   is  anti- 

eucalypti. 

septic,_   used    mostly 

134 

Oleum. 

N. 

insol. 

sol. 

Tri5-30 

0.30-2 

by       inhalation      in 

132 

Eucalyptol  (from  ol. 

N. 

insol. 

sol. 

rri5-3o 

0.30-2 

chronic    catarrhs    of 

134 

eucalypti). 

respiratory        tract; 

134 

Eugenol       (a      con- 
stituent  of   oil    of 
cloves). 

eucalyptol  has  same 
uses. 

Eupatorium,     bone- 

3M-1 

1-4 

Bitter  tonic.      Diapho- 

set (e.  perfoliatum, 

retic.      Used    in    in- 

leaves and  fi.  tops) 

fusion  in  colds    and 

Fluidextractum 

f3M-l 

1-4 

fevers,  dyspepsia. 

eupatorii. 

*Europhen,   28.1    % 

insol. 

sol. 

extern. 

A  ntiseptic.  Substitute 

iodine. 

for  iodoform. 

282 


INDEX  OF  DRUGS 


Solubility  in 

Dose. 

Page 

in 

Drug. 

Reac- 

Gm. or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

Exalgine.     See 

Methy  acetanilid. 

208 

Ferruin,  iron. 

N. 

in  sol. 

insol. 

Tonic.     Restorative  to 

Ferrum      reductum, 

N. 

insol. 

insol. 

■gr.i-5' 

6.06-0.36 

the  blood  in  anemia, 

reduced  iron. 

chlorosis,       amenor- 

♦liquor    ferri     ace- 

ac. 

m2-io 

0.12-0.60 

rhea,   infectious  and 

tatis. 

wasting  diseases. 

Liquor  ferri  et  am- 

ac. 

fol-4 

4-15 

The    preparations 

monii  acetatis. 

may   be   grouped   as 

Basham's  mix- 

follows: 

ture. 

Oxides     and    carbon- 

Ferri   carbonas    sac- 

N. 

part. 

insol. 

gr.    2-10 

0.12-0.60 

ates.      Their  prepar- 

charatus. 

ations    and    reduced 

Massa  f.  carbonatis, 

gr.   1-5 

0.06-0.30 

iron  are  restorative, 

Vallet's  mass. 

but  not  astringent. 

Pilulae  f.  carbonatis 

1-2  pills 

Blaud's  pill. 

Ferri  ohloridum, 

ac. 

V.  s. 

V.  s. 

extern. 

The  mineral  acid  salts 

ferric  chloride. 

of  iron  are  astringent, 

101 

Liquor  f.  chloridi. 

ac. 

m2-io 

0.12-0.60 

and     besides     being 

264 

Tinctura  f.  chloridi. 

ac. 

ms-so 

0.30-2 

tonics,    are    used    as 

Ferri  citras. 

ac. 

sol. 

insol. 

gr.  1-5 

0.06-0.30 

hemostatics.         The 

Ferri  et  ammonii 

N. 

sol. 

insol. 

gr.  1-5 

0.06-0.30 

sulphates  are  largely 

citras. 

used    in     this    way. 

Ferri     et     quininte 

ac. 

sol. 

part. 

gr.  2-10 

0.12-0.60 

The  tincture  of  the 

citras. 

chloride   is   valuable 

Ferri     et     quininffi 

si.  ac. 

V.  s. 

part. 

gr.  2-10 

0.12-0.60 

for  internal  use,  com- 

citras solubilis. 

bining     tonic     prop- 

Ferri     et     strych- 

si.  ac. 

sol. 

part. 

gr.  1-3 

0.06-0.20 

erties    of    iron    and 

ninae  citras. 

hydrochloric  acid.  It 

Ferri  hypophosphis. 

si.  sol. 

gr.  2-10 

0.12-0.60 

has  long  been  used 
both  internally  and 
locally  in  erysipelas. 

Pilulse   ferri  iodidi. 

1  to  2  pills 

The    compound    salts 

213 

Syrupus  f.  iodidi. 

'  N.' ' 

TT15-30 

0.30-2 

possess  special  value 

87 

Ferri  hydroxidum 

insol. 

insol. 

51-4 

4-15 

according      to      the 

262 

ferric  hydrate. 

combination.        The 

Ferri  hydroxidum 

31-4 

4-15 

compounds      with 

cum      magnesii 

ammonium  are  more 

oxido. 

stimulating,          and 

Ferri  phosphas  solu- 

si. ac. 

sol. 

insol. 

gr.  1-5 

0.06-0.30 

those      with      phos- 

bilis. 

phoric  acid  are  ton- 

Ferri pyrophosphas 

si.  ac. 

sol. 

insol. 

gr.  1-5 

0.06-0.30 

ics,   with   more  gen- 

solubilis. 

eral  value  in  wast- 
ing diseases. 

101 

Ferri    sulphas,    fer- 

ac. 

0.9 

insol. 

The   iodide   is   altera- 

264 

rous  sulphate. 

tive,      possessing      a 

Ferri   sulphas  exsic- 

ac. 

sol. 

insol. 

Ur.  H-2 

0.03-0.12 

special      value      for 

catus. 

scrofulous     children. 

Ferri    sulphas    gran- 

ac. 

sol. 

insol. 

The   hydrated   oxides 

ulatus. 

are    the    best    anti- 

101 

*Subsulphate, 
Monsel's  salt. 

sol. 

gr.  1-3 

0.06-0.20 

dotes  in  arsenical 
poisoning,  before  the 

102 

Liquor    ferri    sub- 
sulphatis. 
Monsel's  solution. 

ac. 

rri2-io 

0.12-0.60 

poison  has  been  ab- 
sorbed. See  Table  of 
Poisons. 
The     vegetable     acid 
salts     are     mild     in 
action. 

102 

Liquor  f.   tersulph. 

ac. 

Used   chiefly  to   pre- 

Ferri    et     ammonii 

si.  ac. 

■2;7' 

insol. 

gr!  2-10 

6.12-0.66 

pare  other  salts. 

sulph.,  iron  alum. 

Ferri     et     ammonii 

N. 

V.  s. 

insol. 

gr.  5-15 

0.30-1 

tartras. 

Pilulse  aloes  et  f. 

1  to  3  pills 

Syrupus  f.,  quinines 

;;;;; 

f3M-l 

2-4 

et  strychninae 

phosphatum. 

♦Albuminate. 

sol. 

gr.   10-30 

0.60-2 

88 

*Dialyzed,  scales. 

gr.  1-5 

0.06-0.30 

Recommended   as  an 

liquid. 

fniO-30 

0.60-2 

antidote   to    arsenic, 

Filix  mas.     See  As- 

but      less      valuable 

pidium. 

than  hydrated  oxide 

Flaxseed.     See 

or     hydrated     oxide 

Linum. 

with  magnesia. 

INDEX  OF  DRVGS 


283 


Page 
in 
text. 


Drug. 


Reac- 
tion. 


Solubility  in 


Water   Alcohol 


Dose. 


Gm.  or 
c.c 


Uses. 


148 
148 


Plate 
xviii. 


97 


97 


132 


109 
31 


205 


92 
241 
244 


91 


♦Formaldehyde,    a 
gas. 

Liquorformaldehydi, 
formalin,  37  %. 

Fowler's   solution. 
jSee  under  Arseni 
trioxid. 

Foxglove.    See  Digi- 
talis. 


Frangula  (rhamnus 
f.),  buckthorn 
(bark,  at  least  one 
year  old). 
Fluidextractum 

frangulae. 
Friar's  balsam.     See 

under  Benzoin. 
*Fuchsine,   roseine. 
Galla,  nutgall  (from 
quercus     lusitani- 
ca). 
Tinctura  gallse. 
Unguentum. 
Gambir,  catechu. 
Tinctura  gambir 
composita. 
Trochischi. 
Gamboge.   See  Cam- 

bogia. 
*Gaultheria,  winter- 
green  (leaves). 
Oleum  gaultheriae. 

Spiritus. 
Gelatinum. 
Gelatinum     glycer- 
inatum. 


Gentiana    (g.   lutea, 
root). 
Extractum     gen- 

tianae. 
Fluidextractum. 
Tinctura  comp. 
Ginger.      See   Zingi- 
ber. 
Glauber's  salt.     See 

Sodii  sulphas. 
Glonoin.   See    Nitro 

glycerin. 
Glycerinum. 


N.  or 
si.  ac. 


Suppositoria 
glycerini. 

Glycyrrhiza  _(g.   gla- 
bra"), Ucorice  root. 

Extractum    glyoyr- 
rhizae. 

Extractum  purum. 

Fluidextractum. 

Mistura  comp. 
brown  mixture. 

Pulvis  compositus. 

Trochisci  g.  et  opii. 


N.  or 
si.  ac. 


sol. 


part. 


sol. 


f5H-2 

■■3i-2' 

f51-2 

gr.'io-SO 

f3}^-2 
1  gr.  each 

5M-2 

Tni-5 

f31-2 


gr.  5-30 

gr.  2-10 

ni5-30 
f3l-4 


Tri5-60 


f3l-4 

3J^-2 

1  to  5 

troches 


2-8 


2-8 


4-8 


4-8 
extern. 
0.60-2 

2-8 


2-8 
0.06-0.30 

4-8 


0.30-2 
0.12-0.60 


0.30-2 
4-15 


0.30-4 


freely 

freely 
freely 
4-15 

2-8 


Disinfectant. 
Most  efficient  disin- 
fectant for  rooms, 
clothing,  books,  etc. 
In  solutions  of  1%  or 
less  as  antiseptic.  To 
soft  tissues  a  weak 
solution  must  be  em- 
ployed on  account  of 
its  irritant  action. 
To  preserve  anatom- 
ical specimens. 

Cathartic.  Fresh  bark 
is  harsh,  old  bark  is 
mild  and  efficient.  In 
chronic  constipation. 


Coloring  agent. 

Astringent.  Virtues 
due  to  the  tannic 
and  gallic  acids  con- 
tained. 

Astringent.  Owes  its 
value  to  tannic  acid. 


Aromatic.  Astringent. 
Substitute  for  sali- 
cylic acid  in  rheu- 
matism. Used  as  fla- 
voring agent. 

To  prepare  capsules 
and  suppositories. 
As  coating  for  pills. 
In  hemophilia  by  rec- 
tum or  subcutane- 
ously. 

Bitter  tonic.  Simple 
stomachic  and  gen- 
eral tonic.  Contains 
no  tannin. 


Vehicle.  Solvent.  Pre- 
servative. Locally 
demulcent  and  emol- 
lient. In  enema  or 
suppository  for  con- 
stipation. Applied 
upon  cotton  to  soften 
and  aid  resolution  of 
inflammatory  thick- 
ening of  tissues. 
Sweetening  agent. 

Laxative.      For  intro- 
duction   into    the 
rectum. 

Expectorant.  Demul- 
cent. In  cough  mix- 
tures. To  cover 
taste  of  bitter  drugs. 


Laxative.    Contains 
senna. 


284 


INDEX  OF  DRUGS 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Water   Alcohol 


Dose. 


Gm.  or 
c.c. 


Uses. 


97 


97 


227 


169 


Glycyrrhizinum  am- 

moniatum. 
Gold.     See  Aurum. 
Golden  seal.     See 

Hydrastis. 
Gossypium   purifi- 

catum,  cotton   (g. 

herbaceum,  hairs 

of  seed). 
Oleum  gossypii 

seminis       (cotton- 
seed oil). 
Goulard's  cerate. 
Goulard's  extract. 

See  Plumbum. 
Gray  powder.     See 

Hydrargyrum. 
Green   soap.     *See 

Sapo  mollis. 
Guaiacum(guaiacum 

officinale),    guaiac 

(resin). 
Tinctura  guaiaci. 
Tinctura   guaiaci 

ammoniata. 
Guaiacol.    iSee  under 

Creosotum. 
Guarana    (from 

Paullinia  cupana, 

seeds). 
Fluidextractum 

guaranie. 
Gum  Arabic.     See 

Acacia. 
Guncotton.         See 

PyroxyUnum. 
*Gutta-percha. 

(Soluble  in  chloro- 
form, oil  of  turpen- 
tine, carbon  _  disul 
phide  or  benzin.) 

*Solution. 
Hamamelis,   witch- 
hazel  (h.virginiana 

leaves  and  bark). 
Aqua  hamamelidis. 

Fluidextractum 

Haematoxylon,   log- 
wood (h.  campe- 
chianum,  wood). 
Extractum  hema- 
toxyU. 

Hedeoma,     penny- 
royal (leaves  and 
fl.  tops). 
Oleum  hedeomae. 

*Heroine   (from 
morphine). 

*Heroine    hydro- 
chloride. 

Hexamethylena- 
mina,  urotropin. 

Hive  syrup.    See  un- 
der Scilla. 

Hoffman's   anodyne. 
See  under  vEther. 

*Holocaine    hydro- 
chloride. 

Homatropine.     See 
under  Atropine. 

Honey.    See  Mel. 

Horseradish.     See 
Armoracia. 

Humulus  (h.  lupu- 
lus),  hops. 

♦Tinctura  humuli. 
See  Lupulinum. 


sol. 


insol. 


insol 
sol. 

1.5 
40t 


sol. 


gr.  5-15 


0.30-1      Same  uses  as  licorice. 


To  prepare  surgical 
dressings.  As  ab- 
sorbent. 


gr.  5-30 


f3J^-l 
f3J4-l 


3M-1 


f3! 


0.30-2 


2-4 
2-4 


1-4 


1-4 


insol. 


insol. 
sol. 

10 


3M-2 

f3H-2 
gr.  5-15 

Tni-5 

gr.  Vio-K 

gr.  5-15 


extern. 
2-8 


2-8 


0.30-1 

0.06-0.30 
0.006-0.01 
0.30-1 


f3l-2 


4-8 


Emollient.  Substitute 
for  olive  oil.  Ap- 
plied to  burns,  etc. 


Alterative.  In  rheu- 
matism, gout,  tonsil- 
litis, myalgia,  sci- 
atica and  syphilis. 


Tonic.      Stimulant. 
Similar  in  action  to 
coffee.     Used  in  mi- 
graine. 


Protective.  In  making 
splints  and  surgical 
appliances.  As  tem- 
porary fillingf  or  teeth 
The  solution  is  used 
in  slight  wounds. 

Feeble  astringent.  In 
hemorrhages,  hemor- 
rhoids. Locally  to 
bruises  and  inflam- 
ations. 

Coloring  agent. 


Astringent.  In  diar- 
rhea, hemorrhages. 

Aromatic.  Carmina- 
tive. In  colic.  Used 
also  externally. 

Sedative.  Depresses 
respiratory  centre 
with  less  cerebral 
effect  than  morphine. 
To  relieve  cough. 

Antiseptic.  When 

given  internally  lib- 
erates formaldehyde 
during  elimination 
by  the  kidneys. 

Local  analgesic.  Same 
uses  as  cocaine,  but 
probably  more  toxic. 


Tonic.  Anodyne.  In 
sleeplessness,  deliri- 
um tremens,  fevers. 
Externally — poultice. 


t  Soluble  in  boiling  water,  which  upon  cooling  leaves  a  2}4%  solution. 


INDEX  OF  DRUGS 


285 


Page 
in 
text. 


Drug. 


Reac- 
tion. 


Solubility  in 


Water    Alcohol 


Dose. 


Gm.  or 
c.c. 


Uses. 


212 


142 

212 
264 


212 


211 


201 


Hydrargyrum,  mer 
cury,  a  metal. 

Hydrargyrum      cum 
creta,    gray    pow- 
der, 38%. 
Emplastrum    hy- 

drargyri. 
Massa    hydrargyri, 
blue  pill,  33%. 

Oleatum  (20% 
yellow  oxide). 

Unguentum,  blue 
ointment,   50%. 
Hydrargyrum    am- 
moniatum,  white 
precipitate. 

Unguentum       hy- 
drargyri    ammo- 
niati,  10%. 
Hydrargyri      chlori- 
dum    corrosivum, 
mercuric  chloride, 
corrosive        subli- 
mate. 
Hydrargyri         chlo- 
ridum  mite,   mer- 
curous       chloride, 
calomel. 
*Hydrargyri    cyani- 

dum. 
Hydrargyri  iodidum 

flavum. 
Hydrargyri  iodidum 
rubrum. 

Liquor  arseni  et 
hydrargyri  iodidi, 
Donovan's  solu 
tion. 

Liquor  hydrargyri 
nitratis. 

Unguentum         hy- 
drargyri    nitratis, 
citrine  ointment 
Hydrargyri    oxidum 
flavum. 

Unguentum  hy- 
drargyri oxidi 
flavi,  10%. 
Hydrargyri  oxidum 
rubrum,    red    pre- 
cipitate. 

Unguentum  hy- 
drargyri oxidi 
rubri,  10%. 

*Black  wash  (1 
gram   calomel, 
115.5  c.c.  lime- 
water). 

*Yellow  wash  (1 
gram  corrosive 
sublimate,  308  c.c. 
lime-water.) 
Hydrastis,  golden 
seal  (h.  canadensis, 
root). 

Fluidextractum 
hydrastis. 

Glyceritum,   100%. 

Tinctura. 
Hydrastina. 
Hydrastininae  hy- 

drochloridum. 
Hydrogen    peroxide. 
See  Aq.  hydrogenii 
dioxidi. 
Hydronaphtol.      See 

Betanaphtol. 

*Hyoscine   (from 

hyoscyamine). 

Hyoscinae  hydro- 

bromidum. 


N. 


N. 


insol. 


al. 


aim. 
insol. 


13 


insol. 


12.8 

aim. 
insol. 
aim. 
insol. 


insol. 


gr.   H-10 


gr.  J^-15 


aim. 
insol. 


aim. 
insol. 


aim. 
insol. 


.si.  sol. 


si.  ac. 


insol. 

15 

insol. 

130 


insol. 


insol. 


135 


1.5 


gr.  Veo-Vio 

gr.   J-j-10 

gr.  Veo-Vio 
gr.  Ve-l 

gr.;Vco-Vio 

mi-io 


16 


gr.  5-60 

TT15-60 

1715-60 

f3>^-2 

gr.  H-V2 

gr.  1/12-M 


0.03-0.60 

extern. 
0.03-1 
extern, 
extern, 
extern. 

extern. 

0.001-0.006 


Metallic  mercury  used 
only  in  gray  powder, 
blue  pill,  and  oint- 
ment, in  which  it  ia 
very  finely  divided. 
Preparations  of  mer- 
cury are  alterative 
and  purgative.  It  is 
the  chief  remedy  in 
secondary  syphilis. 
Blue  pill  is  cathartic, 
but  should  be  fol- 
lowed by  a  saline. 
Ointment  and  oleate 
by  inunction  to  ob- 
tain systemic  effect. 


0.03-0.60 


0.001-0.006 
0.01-0.06 


0.001-0.006 
0.06-0.60 


extern. 


1/160- 


extern. 
extern. 

0.30-4 

0.30-4 

0.30-4 
2-8 
0.015-0.03 
0.005-0.01 


0004-.0012 


The  most  poisonous 
salts  are  corrosive 
chloride,  cyanide,  and 
red  iodide. 

Corrosive  subhmate  is 
active  and  efficient 
for  internal  use.  In 
secondary  _  and  ter- 
tiary syphilis,  is  fre- 
quently combined 
with  iodides.  In  dis- 
eases with  fibrinous 
exudation,  it  is  of 
value.  In  dysentery, 
in  weak  solution  by 
enema.  It  is  a  pow- 
erful antiseptic  exten- 
sively used  in  1 :  2000 
or  weaker  solution  as 
douche  or  irrigation. 

Calomel  is  a  mild  and 
certain  cathartic  as 
occasional  purge  in 
fevers  and  inflam- 
matory diseases.  An 
efficient  diuretic  in 
dropsies.  In  diar- 
rheas in  small_  doses. 
In  enterocolitis. 
Locally  as  a  seda- 
tive, alterative  ap- 
plication   to    ulcers. 

Oxides  and  nitrate 
used  externally. 

Black  wash  and  yellow 
wash  are  applied  to 
syphilitic  ulcers. 

Salivation  (which  is 
always  to  be  avoid- 
ed) is  easily  pro- 
duced by  blue  pill 
and  calomel. 

Bitter  tonic.  In  atonic 
indigestion.  Altera- 
tive to  mucous  mem- 
branes. In  diseases 
of  genitourinary  or- 
gans. 


Hemostatic.     In  uter- 
ine hemorrhages, 
dysmenorrhea. 


Hypnotic.     Sedative. 


286 


INDEX  OF  DRUGS 


Page 
in 
text. 


Drug. 


Reac- 
tion. 


Solubility  in 


Water    Alcohol 


Dose. 


Gm.  or 
c.c. 


Uses. 


264 


201 


210 


137 


137 

63 
136 
212 

65 


66 


91 
231 


256 


Hyoscyamus,  hen- 
bane (h.  niger, 
Ivs.  and  fl.  tops). 

Extractum  hyos- 
cyami. 

Fluidextractum. 

Tinotura. 


Hyoscyaminoe  hy- 
drobromidum. 

Hyoscyaminae  sul- 
phas. 

Hypophosphites. 
Syrupus  hypophos- 
phitum. 

Syrupus  hypophos. 
compositus. 

*lohthyocolla,  isin- 
glass. 

*Ichthyol. 
*IjOtion  or  oint- 
ment. 
Indian  hemp.    See 
Cannabis  indica. 
India-rubber.     See 

Elastica. 
*Indigo   (from  sev- 
eral species  of 
indigof  era) . 
Iodine.     See  lodum. 
lodoformum,   iodo- 
form, 96.7% 
iodine. 
Unguentum  iodo- 
formi,  10%. 
lodolum,  iodol,  89% 

iodine, 
lodum,  iodine. 
Liquor     iodi   com 
positus,       Lugol's 
solution,     5% 
dine,    10%    iodide 
of  potassium. 
Tinctura  iodi,  7%. 
Unguentum,      4% 
*Decolorize(i    tinc- 
ture. 
Ipecacuanha,  ipecac 
(cephaelis  i.  root) 
Fluidextractum 
ipecacuanhse. 
Syrupus,  7%. 
Pulvis  i.  et  opii.  See 

under  Opium. 
Tinctura  i.  et  opii. 
See  under  Opium. 
*Troehisci. 

Vinum,   10%. 
See  Emetine. 


*Iris  florentina,  orris 
root. 
*Tincture. 

*Oil  of  orris  root. 

Iron.     See  Ferrum. 

Isinglass.  See  Ich- 
thyocolla. 

Itrol.  See  Argenti 
citras. 

Jaborandi.  See  Pilo- 
carpus, 


N. 
N. 

si.  ac. 

N. 

V.  s., 
0.5 

part, 
sol. 

aim. 
insol. 

insol. 
5000 

2 
6.4 


insol. 
part. 


46.7 


9 
10 


gr.  5-15 


gr.  M-2 

rn5-i5 
f3l-4 


gr.  i/eo-Vsi 


gr. 


-i/s: 


f3i-2 

fol-2 


gr.  1-3 
gr.  3^-3 

■  nji-io  ■ 
nii-5 

gr.  1-30 

fTni-5 

lTni5-30 

rn5-f52 


.gr.  H 
in  each 

mi-60 


5«-i 
f3l-2 


0.30-1 


0.03-0.12 


0.30-1 
4-15 


In  action  it  is  similar 
to  belladonna,  but 
more  sedative  and 
hypnotic.  In  insom- 
nia, mania,  deli"ium 
tremens.  It  quiets 
peripheral  irritation, 
nervous  cough,  irri- 
tability of  bladder. 

0. 001-0. 002|Hyoscyamine  is  ano- 
dyne and  mydriatic. 

0.001-0.002 


Tonic.     Restorative. 
In  wasting  diseases, 
tuberculosis,  rachitis, 
nervous  diseases. 


4-8 

4-8 

freely. 


extern, 
extern. 


0.06-0.20 

extern. 
0.03-0.20 

6.06-0.66 


0.06-0.30 
extern, 
extern. 

0.06-2 

0.06-0.30 

1-2 

0.30-8 


0.06-4 


1-4 

4-8 


Demulcent.  Protect- 
ive. In  pharmacy  as 
a  clarifying  agent. 

Antiseptic.  Alterative. 
Applied  to  skin  dis- 
eases, inflammations. 


Coloring  agent. 


Used  externally.  Alter- 
ative. Antiseptic.  As 
powder  to  wounds 
and  ulcers. 

Antiseptic.  Same  uses 
as  iodoform. 

Alterative.  Antiseptic. 
In  tertiary  syphilis, 
scrofula,  glandular 
enlargements.  In- 
ternally mostly  in 
the  form  of  iodides. 
The  tincture  is  much 
used  as  a  counter- 
irritant.  _  Vapor  in- 
haled in  phthisis. 
Used  in  dysentery  in 
in  full  doses. 

Expectorant. 

Emetic  in  large  doses. 
One  of  the  safest 
emetics.  Syrup  may 
be  given  to  children 
in  croup  and  bron- 
chitis to  rid  air  pas- 
sages of  mucus.  In 
cough  mixtures.  The 
wine  in  drop  doses  to 
check  vomiting.  In 
diarrheas  combined 
with  other  remedies. 
Diaphoretic  when 
combined  with 
opium. 

Used  chiefly  in  tooth 
powders.  Tincture  in 
perfumery  and  aS 
flavoring. 

Perfume. 


INDEX  OF  DRUGS 


287 


Solubility  in 

Dose. 

Page 

in 

Drug. 

Reac- 

Gm. or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

Plate 

Jalapa  (ipoma?a  j., 

gr.  5-20 

0.30-1.30 

Hydragogue   cathartic. 

xviii. 

root). 

In  dropsies.  At  com- 

*Extractum jalapae. 

gr.  2-8 

0.12-0..50 

mencement  of  acute 

Pulvis  comp. 

3J^-2 

2-8 

fevers  or  inflamma- 

Resina. 

si.  ac. 

insol. 

sol. 

gr.  1-10 

0.06-0.60 

tions.  As  revulsive 
or  depleting  agent  in 
cerebral  hyperemia 
or  serous  effusions. 

*Juniperus    commu- 

3}€-i 

1-4 

Stimulant  diuretic. 

nis  (ripe  fruit). 

Usually       combined 

230 

Oleum  juniperi. 

in  sol. 

10 

ni2-io 

0.12-0.60 

with  other  diuretics. 

Spiritus. 

f5J^-i 

2-4 

In  drop.sies,  chronic 

Spiritus  comp. 

f3l-4 

4-15 

catarrhs    of    urinary 

♦Infusion. 

f5}^-2 

15-60 

tract. 

97 

Kino      (pterocarpus 
marsupium,_      in- 
spissated juice). 
Tinctura  kino. 

slowly 
sol. 

sol. 

gr.  5-30 

f5J€-2 

0.30-2 
1-8 

Astringent.  In  diar- 
rheas.    As  gargle. 

97 

Krameria,     rhatany 
(k.  triandra  and  k. 
ixina,  root). 

gr.  5-30 

0.30-2 

Astringent.  In  diar- 
rheas, hemorrhages. 
Locally    to    relaxed 

Extractum         kra- 

gr.  5-10 

0.30-0.60 

mucous  membranes, 

meriae. 

spongy    gums.       As 

Fluidextractum. 

ni5-30 

0.30-2 

injection    in    fissure 

Syrupus. 

f  3  1-^-4 

2-15 

of    anus    or    hemor- 

Tinctura. 

f3J^-2 

2-8 

rhoids. 

Trochisci. 

1-5 

Labarraque's      solu- 

troches. 

tion.      See    under 

Chlorine. 

Lactucarium,  lettuce 

gr.  5-60 

0.30-4 

Mild  sedative  and  hyp- 

(lactuca       virosa, 

notic,  somewhat  hke 

concrete  juice). 

opium,      but     much 

Syrupus  lactucarii. 

f3l-4 

4-15 

feebler.    Used  chiefly 

Tinctura. 

f3K-2 

1-8 

as  vehicle. 

Lanolin.     See  Adeps 

lanse  hydrosus. 

Lard.     See  Adeps. 

Laudanum.    See  un- 

der Opium. 

Laughing    gas.      See 

Nitrous  oxide. 

♦Lavandula          offi- 

cinalis,     lavender 
(flowers). 
Oleum      lavandulae 

mi-5 

0.06-0.30 

Flavoring   agent.      As 

florum. 

carminative. 

Spiritus. 

f3J^-l 

2-4 

Tinctura  comp. 

foH-1 

2-4 

Lead.        See    Plum- 

bum. 

Lemon      peel.      See 

Limonis  cortex. 

Licorice     root.     See 

Glycyrrhiza. 

Lily   of    the    valley. 

See  Convallaria. 

Lime.     See  Calx. 

Limonis            cortex, 

Preparations  of  lemon 

lemon  peel. 

peel  used  chiefly  as 

Oleum  limonis. 

3 

rri2-io 

0.12-0.60 

flavoring  agents.  The 

♦Spiritus. 

freely 

syrup  of  citric  acid 
as  vehicle. 

Limonis      _    succus, 

ao. 

freely. 

Antiscorbutic.            In 

lemon- juice. 

scurvy,   acute   rheu- 

*Syrup. 

ac. 

freely. 

matism.    Refrigerant 

Syrupus    acidi    cit- 

ac. 

■  if3 1-4  ■ 

4-15 

drink  in  fevers.     To 

rici. 
Linseed  oil.    See  un- 
der Linum. 

lessen  acidity  of 
urine.    As  vehicle. 

91 

Linum    (1.    usitatis- 

In  poultices.  Infusion 

simum),    flaxseed. 

as    demulcent    drink. 

90 

Oleum  lini,  linseed 

oil. 
♦Infusion. 
Liquorice  root.     See 

Glycyrrhiza. 
Litharge.   See  Plum- 

bi  oxidqm. 

f5>^-2 

1.5-60 
freely. 

Oil  is  demulcent.  Ap^ 
plied  freely  to  burns. 

288 


INDEX  OF  DRUGS 


Drug. 


Reac- 
tion. 


Solubility  in 


Water 


Alcohol 


Dose. 


Gm.  or 
c.c. 


Uses. 


137 


116 


Plate 
xviii. 


140 


♦Lithium,  a  metal. 
Lithii  benzoas. 
Lithii  bromidum. 
Lithii  carbonas. 
Lithii  citras. 

Ijthii    citras    effer- 
vescens. 
Lithii  salicylas. 

*Litmus,  lacmus. 
♦Tincture. 

Lobeha    (1.    inflata), 

Indian         tobacco 

(leaves  and  tops). 

Fluidextractum  lo- 

beliffi. 
Tinctura. 

*Lobeline  (alkaloid). 

Logwood.  See  Heb- 
matoxylon. 

*Losophane,  cresol 
triiodide,  78%  io- 
dine. 

Lugol's  solution.  See 
under  ledum. 

Lunar   caustic.      See 
under  Argentum. 

Lupulinum        (from 
humulus)     (gland 
ular  powder). 
Fluidextractum 

lupulini. 
Oleoresina. 

Lycopodium  (1.  cla- 
vatum  and  other 
species)  (sporules) 

*Lysol    (from     coal 

tar). 
*Macis,    mace    (aril- 
lode  of  nutmeg). 
Oil    of   mace.      <See 
under  Myristica. 
♦Magnesium,  a  metal 
Magnesii  carbonas 

Magnesii  oxidum. 
Magnesii       oxidum 

ponderosum, 

heavy  mag.  oxide, 
Magnesii      sulphas 

Epsom  salt. 
Male  fern.     See  As- 

pidium. 


Malt,    barley    malt. 

Extractum  malti. 
Mandrake.     See  Po- 
dophyllum. 
♦Manganum,  manga- 
nese. 
Mangani  dioxidum. 

Potassii       perman- 
ganas. 

Manna    (from    frax- 

inus  ornus). 
Mastiche,      a  _  resin 

from  pistacia  len- 

tiscus. 
May  apple.     See 

Podophyllum. 


si.  al. 

si.  al. 

al. 

N. 


si.  ac. 


3 

0.6 
75 
2 


13 

V.  s. 
insol. 

aim. 
insol. 


aim. 
insol. 
spar, 
spar. 

0.85 


insol. 
15 


insol. 


insol. 


insol. 
insol. 


insol. 


insol. 
t 


part. 


gr.  5-20 
gr.  5-20 
gr.  2-10 
gr.  5-20 

gr.  10-45 

gr.  5-30 


gr.  1-10 


mi-io 
ms-so 

gr.  y2-i 


gr.  5-30 

rn5-30 

gr.  1-5 


extern, 
gr.  5-20 

gr.  5-60 
gr.  5-60 


f  o  1-4 


gr.  2-10 
gr.  ^-2 

5}^-2 


0.30-1.30 
0.30-1.30 
0.12-0.60 
0.30-1.30 

0.60-3 

0.30-2 


0.06-0.60 


0.06-0.60 


0.30-2 
0.03-0.06 


0.30-2 

0.30-2 
0.06-0.30 


0.30-1.30 


0.30-4 
0.30-4 


8-30 


4-15 

0.12-0.60 
0.03-0.12 

15-60 


Antacid.  Diuretic. 
Salts  used  to  pro- 
duce alkalinity  of 
urine.  In  uric  acid 
diathesis,  gout;  the 
uric  acid  reacts  with 
the  salt  to  form 
urate  of  lithium,  the 
most  soluble  urate. 

Coloring  ag't.  To  pre- 
pare test  paper  for 
acids  and  alkalies. 

Emetic.  Expectorant. 
Too  harsh  as  an 
emetic.  Used  as  anti- 
spasmodic in  asthma. 
In  bronchitis.  Has 
been  used  in  poison- 
ing by  poison  ivy. 


Antiseptic.  Locally 
in  solution  or  oint- 
ment in  parasitic 
skin  diseases,  but 
not  when  acute  in- 
flammation is  pres- 
ent. 

A  nodyne.  Diaphoretic. 
In  sleeplessness,  de- 
lirium tremens.  Sub- 
stitute for  alcohohcs 
for  inebriates. 

Applied  to  excoriated 
surfaces  as  protective 
and  absorbent.  In 
preparing  pills. 

Disinfectant.  Used  in 
solutions  of  1  or  2%. 

Aromatic  stimulant. 
Carminative. 


Antacid.  Laxative.  In 
acidity    of    stornach. 

To  prepare  antidote 
to  arsenic.  Light 
and  heavy  oxides 
and  carbonate  are 
mild  laxatives.  The 
sulphate  is  active 
cathartic.  As  cath- 
artic in  fevers,  in- 
flammations, ob- 
struction to  portal 
circulation,  dropsies. 

Food  tonic.  Digesiant. 
In  wasting  diseases. 
To  aid  digestion  of 
starch. 


Tonic  in  small  doses. 
Emmenagogue. 

Antiseptic.  Used  lo- 
cally in  diphtheria, 
scarlatina,  etc. 

Demulcent.     Laxative. 

In  dentistry  to  _  fill 
cavities  of  carious 
teeth  temporarily. 


t  Decomposition  occurs. 


INDEX  OF  DRUGS 


289 


Page 
in 
text. 


135 


135 


226 

Plate 

xvii. 

265 


128 


267 


Drug. 


Reac- 
tion. 


Solubility  in 


Water   Alcohol 


Dose. 


Gm.  or 

CO. 


Uses. 


Mel,  honey. 

Mel  depuratum. 
Mentha         piperita, 
peppermint 
(leaves  and  tops). 
Aqua  menthae  pip- 

eritse. 
Oleum. 
Spiritus. 


Menthol,  a  stea- 
ropten  from  oU  of 
peppermint. 

Mentha     viridis, 
spearmint    (leaves 
and  tops). 

Aqua  menthae  v. 

Oleum. 

Spiritus. 

Menthol.  .See  under 
Mentha  piperita. 

Mercury.  See  Hy- 
drargyrum. 

♦Methyl  acetanilid, 
exalgine. 

Methyl  salicylas, 
artificial  oil  of 
wintergreen. 

MethylthioninEB 
hydrochloridum, 
methylene  blue. 

♦Methylene  bichlo- 
ride. 

♦Methylene  chloride. 

Monsel's  salt.  See 
under  Ferrum. 

Morphina      (from 
opium). 

Morphinae  acetas. 

Morphinae      hydro- 
chloridum. 
Morphinae   sulphas, 
Pulvis    morphinae 
compositus.      Tul 
ly's  powder. 
Mustard.       See  Sin- 
apis. 
♦Myrcia     acris,    bay 

(leaves). 
♦Spiritus      myrciae, 

bay  rum. 
Myristica    (m.    fra- 
grans),  nutmeg. 
Oleum  myristicse. 
♦Fixed  oil,  nutmeg 
butter.     Oil  of 
mace. 
Myrrha,  a  gum  resin 
from   commiphora 
myrrha. 
Tinctura  myrrhae 

Naphtalenum    (from 

coal    tar),     naph- 

tahn. 
Naphtol.     See  Beta- 

naphtol. 
♦Nicotine  (from 

tabacum). 
♦Nirvanin. 


si.  ac. 


N. 


N.  or 
si.  ac. 


N. 


al. 


N.  or 
si.  al. 

N. 


sol. 


si.  sol. 


insol. 
sol. 


3330 

2.25 
17.2 
15.3 


insol. 


part. 


insol. 


V.  s. 
V.  s. 


sol. 


sol. 


sol. 
si.  sol. 


168 

216 

42 

465 


part. 


15 


V.  s. 

V.  s. 


f5H-2 
rni-5 

tn5-i5 


gr.  1-3 


f3^-2 
Tni-5 

rn5-i5 


gr.  H-3 
Tni-5 

gr.  1-5 


gr.  Vs-K 

gr.   Vs-M: 

gr.  H-H 
gr.  5-15 


gr.  5-15 

nii-3 


foM-1 
gr.  1-10 

TTlVso-Vio 
gr.  H-5 


freely. 


15-60 


0.06-0.30 
0.30-1 


0.03-0.20 


15-60 
0.06-0.30 

0.30-1 

0.03-0.20 
0.06-0.30 

0.06-0.30 


Vehicle.     Demulcent. 

A  romatic  stimulant 
The  water  as  ve- 
hicle. All  prepara- 
tions as  carminative 
in  flatulence,  coUc, 
nausea.  The  oil  lo- 
cally applied  is  ano- 
dyne. Diluted  to  re- 
heve  pruritus. 

Menthol  locally  as 
anodyne  in  head- 
aches. Internally  as 
antiseptic. 

Similar  to  pepper- 
mint, but  weaker. 

As  vehicle. 


Analgesic.   Antiseptic. 

In   neuralgia. 
Same    uses    as    oil   of 

gaultheria. 

Coloring  agent. 


Anesthetic.  Not  so  safe 

as  ether. 
Anesthetic.      Used 

mostly  locally. 

0.007 5-.015  Anodyne.  In  large 
doses  narcotic.  Uses 
same     as     those     of 

0.0075-.015,  opium,  but  it  is  less 
constipating  and 

0.0075-.015!  acts  more  quickly. 
Preferred   for   hypo- 

0.0075-.015  dermic  use.  Poison- 
0..30-1  ing  and  habitual  use 
must  be  guarded 
against. 


extern. 


0.30-1 


0.06-0.20 
extern. 


As  lotion  and  per- 
fume. 

Aromatic.  Stimulant. 
In  large  doses  nar- 
cotic. Used  as  a  con- 
diment. As  carmina- 
tive. The  volatile 
oil  is  rubefacient. 

Tincture  locally  as 
antiseptic  and  stimu- 
lant to  mucous  mem- 
branes. Apphed  to 
spongy  gums. 
0.06-0.60  Antiseptic,  internally 
and  externally. 
Source  of  naphtol. 


0.002-0.006  Sedahre.      Poisonous. 

0.03-0.30  Local  analgesic.  Same 
uses  as  cocaine,  being 
less  toxic. 


1-4 


19 


290 


INDEX  OF  DRUGS 


Page 


Drug. 


203 

Plate 

xiii. 

265 


184 


202 
206 
Plate 
xi. 
265 


132 
134 
210 


Plate 
xviii. 


Plate 
xviii. 
264 
225 

Plate 
xvii. 
265 


Reac- 
tion. 


238 


226 


♦Nitroglycerin,  glo- 
noin. 

Spiritus  glycerylis 
nitratis,  1%  solu- 
tion in  alcohol. 


♦Nitrous  oxide, 

laughing  gas. 
Nutgall.     See  Galla. 
Nutmeg.    See  Myns- 

tica. 
Nux  vomica  (strych- 

nos  n.  v.,  seeds). 
Extractum       nucis 

vomicae. 

Fluidextractum. 
Tinctura. 
See  Strychnina. 

Oleum  betulae,  oil  of 

sweet  birch. 
Oleum  cadinum(from 

juniperus   oxyced- 

rus),   oil   of  cade._ 
Oleum   caiuputi,   oil 

of  cajuput. 
Oleum  morrhua, 

cod-liver  oil. 
Emulsum  olei 

morrhuse. 
Emulsum  o.  m.     _ 

cum  hypophosphi- 

tibus. 
Oleum  olivee.ohve  oil 
Oleum  ricini,  castor 

oil. 
Oleum     santah,     oil 

of  sandal-wood. 
Oleum  tiglii,  croton 

oil. 

Opium.  Concrete 
juice  of  unripe  cap 
sules  of  opium 
poppy  (papaver 
somniferum).  con 
taining  not  less 
than  9%  mor- 
phine. 

Opium    deodor- 
atum. 

Opium  granulatum, 

Opii  pulvis, 
each  contains  12- 
12.5%     morphine. 

Extractum  opii. 

Pilulse  opii. 

The  following  con- 
tain each  10% 
opium: 

Acetum  opii,  black 
drop. 

Tinctura  opii,  laud 
anum. 

Tinctura  opii  deo 
dorati. 

Tinctura  ipecacu 
anhae  et  .9Pii. 

Vinum  opii. 

Pulvis  ipecacuanha? 
et  opii,  Dover's 
powder,   10% 
opium. 

Tinctura  opii  cam 
phorata,  paregor- 
ic, 0.4%  opium. 


Solubility  in 


Water   Alcohol 


sol. 


N. 
ac. 

N. 
si.  ac. 


Dose. 


Gm.  or 
c.c. 


Uses. 


si.  ac. 
ac. 


insol. 


aim. 
in.sol. 


insol. 
insol. 


insol. 
insol. 


insol. 
insol. 


sol. 
part. 

1 
si.  sol. 


si.  sol. 

1 


sol. 
60 


gr.  i/20o-'/50  ,0.0003-.001 


nii-3 


gr.  1-4 
gr.  K-1 


nii-4 

TT15-30 


mi-s 


mi -5 
f5l-4 
f32-8 
fo2-8 


f5M-2 
ni2-io 

mM-2 

gr.  Ji-2 


0.06-0.20 


inhaled. 


0.06-0.25 
0.0075-0.06 


0.06-0.25 
0.30-1.30 


0.06-0.30 


Arterial  stimulant. 
In  cardiac  diseases, 
arteriosclerosis;  ner- 
vous disorders  de- 
pending upon  arte- 
rial tension;  angina 
pectoris;  headache 
and  neuralgia. 

Anesthetic.  Has  very 
transient  effect, 

therefore        suitable 
for  slight  operations. 

Bitter  tonic.  Stimu- 
lant to  nervous  sys- 
tem. In  atonic  indi- 
gestion, gastric  ca- 
tarrh. In  paralysis, 
incontinence  of  urine 
neuralgia,  and  respi- 
ratory and  cardiac 
weakness. 

Same  uses  as  oleum 
gaultheriae. 

Externally.     In 
scabies,  psoriasis. 


0.06-0.30    Stimulant.  Antiseptic. 
As  carminative. 
4-15         Tonic.    Alterative.    As 
a  fatty  food  in  wast- 
-30  ing  diseases. 

8-30 

freely. 
8-60 

0.12-0.60 

0.015-0.12 

0.015-0.12 


gr.  H-114  0.015-0.10 


gr.  H-1     ,0.0075-0.06 
gr.  1  in 
each. 


tn3-15 


gr.  3-15 

fni3-20 
J  child. 
1f5i-4 
Udult. 


0.20-1 


0.20-1 

0.20-1.20 

4-15 


Laxative.      Emollient. 
Cathartic. 

Alterative.  Gonorrhea, 
chronic  bronchitis. 

Drastic  cathartic;  used 
as  revulsive.  Extern- 
ally it  is  vesicant. 

Anodyne  and  narcotic. 
Danger  of  poisoning 
and  habitual  use 
must  be  guarded 
against.  It  lessens 
secretions  except 
perspiration.  Mod- 
erate doses,  accord- 
ing to  some,  stimu- 
late the  heart.  After- 
effects of  a  full  dose 
are  headache,  nausea 
and  constipation. 
Used  to  relieve  pain 
and  spasm.  In  diar- 
rhea and  dysentery 
to  lessen  peristalsis. 
In  pneumonia,  broii- 
chitis,  and  pleuritis 
to  allay  pain  and 
cough.  In  peritonitis, 
typhoid  fever,  typh- 
Utis,  etc.,  to  lessen 
pain  and  peristalsis. 
In  heart  diseases 
with  angina  pectoris 
or  cerebral  anemia. 
Dover's  powder  is 
diaphoretic,  very  use- 
ful in  pulmoriary  dis- 
eases, myalgia,  lum- 
bago, etc.  For  hypo- 
dermic use  morphine 
is  preferred. 


INDEX  OF  DRUGS 


291 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Water   Alcohol 


Gm.  or 
c.c. 


Uses. 


29 


90 


74 
123 
262 


124 


130 


209 


Trochisci       glycyr- 

rhizae  et  opii. 
See  Codeina  and 

Morphinae. 
Orange     peel.       See 

Aurantii  cortex. 
Orris  root.     See  Iris 

florentina. 
♦Orthoform. 
Otto    of   rose. 

under   Rosa 
♦Oxygen. 


See 


Pancreatinum,    pan- 
creatin. 


ParafEnum  (from  pe- 
troleum). 

Paraldehydum. 

Paregoric.  See  under 
Opium. 

Pearson's  solution. 
See  under  Arseni 
trioxid. 

Pennyroyal.       See 
Hedeoma. 

Pepo,  pumpkin  seed. 

Pepper,    Cayenne. 
See  Capsicum. 

Peppermint.  See 

Mentha  piperita. 

Pepsinum,  pepsin. 

Peroxide  of  hydro- 
gen. See  Aqua  hy- 
drogenii  dioxidi. 

Petrolatum,  vase- 
line. 

Petrolatum  album, 
albolene. 

Petrolatum  liquid- 
um. 

Petroleum,  coal  oil. 

Phenacetin.  See 

Acetphenetidinum 

Phenol,  carbolic  acid, 

Phenol   liquefactum, 
86.4%. 
Glyceritum    pheno- 

lis,  20%. 
Unguentum,  3%. 
*Liquor    sodii    car- 
bolatis,  phenol  so- 
dique. 
*Phenolphthalein. 

PhenyUs  salicylas, 
salol. 


Phosphorus. 
Pilulse  phosphori. 
See    Acidum    phos- 

phoricum. 
See    Hypophos- 
phites. 


N.  or 
si.  ac. 


si.  ac. 


si.  ac. 


N. 


si.  sol 


sol. 


insol. 


siA. 


50 


19.6 


si.  sol. 
2333 


insol. 


1-4 
troches. 


gr.  1-15 


insol. 

gr.  5-15 

insol. 

extern. 

misc. 

f3M-l 

51-3 

insol. 

gr.  1-10 

V.  s. 

gr.  H-2 

local  use. 

10 

gr.  1-10 

5 

gr.  1-10 

350t 

gr.  Vioo-i/m 
.gr.  i/ino 
in  each. 

0.06-1 


inhaled. 


0.30-1 


1-4 


30-90 


0.06-0.60 


0.03-0.12 


Analgesic.  Applied 
locally  to  painful 
ulcers  or  wounds. 

ResUrrative.  In  pul- 
monary diseases,  ap- 
nea, croup,  diph- 
theria; also  used 
with  anesthetics. 

Digestant.  Aids  di- 
gestion of  starches, 
fats  and  proteids; 
also  used  to  pepton- 
ize milk  and  other 
foods  before  feeding. 

Protective.  To  protect 
surfaces  from  moist- 
ure or  air. 

Hypnotic.  I^ess  cer- 
tain than  chloral, 
but  safer. 


Anthelmintic.  Given 
in  emulsion  to  re- 
move tapeworm. 


Digestant.  In  indi- 
gestion due  to  lack 
of  gastric  juice. 


Basis  for  ointments. 

Locally  and  as  ve- 
hicle. 

Source  of  rhigolene 
benzin,  petrolatum, 
paraffin,    etc. 

Corrosive.  A  ntiseptic. 
Local  sedative  in  di- 
lute solution.  As 
mouth-wach,  gargle 
or  internal  antisep- 
tic. In  \-omiting, 
diarrhea,  and  indi- 
gestion due  to  fer- 
mentation. 


0.06-0.60 


0.06-0.60 


Cathartic.       Safe   and 
efficient.     Reagent. 

Intestinal  antiseptic. 
In  diarrhea,  fermen- 
tative indigestion, 
rheumatism. 
Q.0006-.001  Restorative  tonic.  In 
depressed  conditions 
of  nervous  system, 
neuralgia.  _  Largely 
employed  in  form  of 
phosphoric  acid, 
phosphates,  and  hy- 
pophosphites  as  gen- 
eral restorative  in 
wasting  diseases. 


t  Absolute  alcohol. 


292 


INDEX   OF  DRUGS 


1 
Solubility  in     | 

Do 

-e. 

Page 
in 
text. 

Drug. 

Reac- 
tion. 

Water  1 

Alcohol 

Gm.  or 
c.c. 

Uses. 

j'hysostigma,   cala-   | 

gr.  >^-2 

0.03-0.12 

Sedative.    Myotic.   To 

bar  bean. 

depress     excitability 

Extractum  physos- 

gr.  1/10-^ 

0.006-0.03 

of  spinal  cord.       In 

tigmatis. 

tetanus,     strychnine 

Tinctura. 

TniO-30 

0.60-2 

poisoning,      progres- 

*Eserine (similar  to 

sive  paralysis  of  the 

physostigmine). 

insane.    To  contract 

*Physostigmine. 

pupil. 

Physostigminae  sali- 

ac. 

72.5 

12.7 

gr.  V100-V30 

0.0006-.002 

To  contract  pupil. 

cylas. 

Physostigminse  sul- 

ac. 

V.  s. 

V.  s. 

gr.  1/100-^/30 

0.0006-.002 

phas. 

Pilocarpus   (p.   jabo- 



gr.  5-60 

0.30-4 

Powerful    diaphoretic. 

randi,  leaflets). 

Sialagogue.  In  acute 

Fluidextractum 

ni5-60 

0.30-4 

catarrh,     acute     in- 

pilocarpi. 

flammations    of    ser- 

230 

Pilocarpinffi     hydro- 
chloridum. 

N. 

0.3 

2.3 

gr.  H-M 

0.0075-0.02 

ous  membranes.  In 
acute  sthenic  fevers 

Pilocarpine   nitras. 

ac. 

4 

60 

gr.  K-M 

0.0075-0.02 

and    dropsies    when 

PUulffi         catharticEe 

heart    is_  not    weak. 

comp.      See  under 

Pilocarpine   may   be 

Colocynthis. 

used  hypodermic- 

Pilulffi        catharticee 

ally. 

veg.    See        under 

Colocynthis. 

Piperina       (from 

N. 

insol. 

15 

gr.  1-5 

0.06-0.30 

Aniiperiodic.        Anti- 

pepper). 

pyretic. 

*Piperazine,      piper- 

sol.   • 

gr.  8-15 

0.50-1 

As    solvent    for    uric 

azidine. 

acid.  In  gout  and 
allied  conditions. 

Pix     liqtiida,     wood 

ac. 

si.  sol. 

sol. 

foM-1 

1-4 

Esed     externally     in 

tar    (from   pine). 

chronic  eczema,  pso- 

Oleum picis 

extern. 

riasis.   _  With    atom- 

hquidae. 

izer  or  in  the  form  of 

Syrupus. 

f5i-4 

4-15 

syrup    in    laryngitis. 

tnguentum,  50%. 

extern. 

bronchitis,   catarrhs, 

Plaster  of  Paris.  See 

phthisis. 

under  Calcium. 

*Platinum,  a  metal. 

*Platinic  chloride. 

V.  s. 

V.  s. 

gr.  J^-2 

0.03-0.12 

Alterative. 

*Plumbum,  lead. 

104 

Piumbi  acetas, 

N. 

2 

30 

gr.  Ji-5 

0.03-0.30 

Sedative.      Astringent. 

264 

sugar  of  lead. 
Ceratum        piumbi 
subacetatis,    Gou- 
lard's cerate. 

extern. 

Acetate  used  as  seda- 
tive application  to 
irritable  ulcers;  in 
skin   diseases.        As- 

Liquor piumbi  sub- 

al. 

extern. 

tringent    in    inflam- 

acetatis, Goulard's 

mations    and    catar- 

extract. 

rhal  discharges.     In- 

104 

Liquor  piumbi  sub- 
acetatis      dilutus, 
lead-water. 

al. 

extern. 

ternally  in  hemor- 
rhages, diarrheas, 
gastric  ulcer.    Iodide 

Piumbi  iodidum. 

N. 

1300 

spar. 

gr.  i/jo-1/5 

0.006-0.012 

as        ointment        in 

Piumbi  nitras. 

ac. 

1.85 

spar. 

extern. 

chronic   eczema   and 

Piumbi         oxidum, 

al. 

aim. 

insol. 

extern. 

psoriasis.    Nitrate  as 

litharge. 

insol. 

deodorant      to      foul 

Emplastnun  pium- 

extern. 

ulcers.  With  glycerin 

bi,     lead     plaster. 

as  astringent   to  fis- 

Diachylon plaster. 

sured  nipples.    Oxide 

Enguentum    diach- 

extern. 

used  to  prepare  lead 

ylon. 

plaster,  which  forms 
the  basis  of  many 
other  plasters. 

Plate 

Podophyllum,   man- 

gr. 5-20 

0.30-1.30 

Cathartic.    Efficient  in 

x^•iii. 

drake     (p.     pelta- 
tum,  root). 

torpor  of  the  liver. 
In  chronic  constipa- 

*Extractum     podo- 

gr.  2-10 

0.12-0.60 

tion.    The  resin  used 

phylU. 

in  laxative  pills. 

Fluidextractum. 

ni5-20 

0.30-1.20 

Resina,  "podophyl- 
Un."  _ 
*Potassium,  a  metal. 

insol. 

sol. 

ST.  Vs-l 

0.0075-0.06 

Alkali.       Potass,    hy- 

229 

Potassii  acetas. 

Liquor   potassii 
arsenitis.     See  un- 
der Arseni  triox. 

'ki.' 

"OA 

'"2 

gr'.  5-60 

'  6!36-^4  ■ 

droxide  and  potassa 
with  hme  are  caustic. 
Liq.  pot.  hydrox.  di- 
luted, and  the  carbo- 

Potassii biear- 

al. 

3 

aim. 

gr.  5-60 

0.30-4 

nates  are  used  as  al- 

bonas. 

insol. 

kalies. 

229 

Potassii     bitartras. 

ac. 

200 

si.  sol. 

5J^-4 

2-15 

266 

cream  of  tartar. 

Index  of  drugs 


^9S 


Solubility  in 

Dose. 

Page 

in 

Drug. 

Reac- 

Gm. or 

CO. 

Uses. 

text. 

tion. 

Water 

Alcohol 

218 

Potassii  bromiduta. 

N. 

1.5 

180 

gr.  5-60 

0.30-4 

The  salts  with  vege- 

Potassii carbonas. 

al. 

0.9 

insol. 

gr.  5-30 

0.30-2 

table  acids   also   act 

139 

Potassii  chloras. 
Trochisci    potassii 
chloratis. 

N. 

16 

si.  sol. 

gr.  3-20 

gr.  2H  in 

each. 

0.20-1.30 

as  alkalies,  being  con- 
verted into  carbon- 
ates  in   the   system. 

229 

Potassii  citras. 

al. 

0.5 

si.  sol. 

gr.  5-30 

0.30-2 

and    in    elimination 

Liquor  potassii 

al. 

f31-8 

4-30 

they  are  diuretic.    In 

citratis. 

fevers,    rheumatism. 

Potassii  cyanidum. 

al. 

2 

si.  sol. 

gr.  1/20-M 

0.003-0.015 

To   produce   alkalin- 

74 

Potassii        hydrox- 

al. 

0.4 

2 

ity  of  the  urine.     Bi- 

266 

idum,     caustic 
potash. 

tartrate  and  Rochelle 
salt     are    cathartics. 

Liquor  potassii  hy- 

al. 

ni5-i5 

0.30-1 

Chlorate   is  detergent 

droxidi,  6%. 

well  di- 
luted. 

when  applied  to  mu- 
cous membranes.    In 

*Potassa  cum  calce, 

al. 

extern. 

pharyngitis  and  lar- 

Vienna paste,  50% 

yngitis,  used  locally. 

each    potash    and 

Best   used   alone,  as 

lime. 

it  may   form  explo- 

Plate 

Potassi      et      sodii 

al. 

1.2 

aim. 

§J€-1 

8-30 

sive          compounds. 

xviii. 

tartras,     Rochelle 
salt. 
Pulvis   effervescens 
compositus,    Seid- 
litz  powder. 

insol. 

1  set  of 
powders. 

Nitrate  is  diuretic. 
Nitre  paper  as  a 
fumigation  in  asth- 
ma. Sulphate  is  a 
mUd     cathartic,     but 

Potassii  hypophos- 

N. 

0.5 

7 

gr.  5-20 

0.30-1.30 

seldom   used;   useful 

phis. 

to  hasten  the  hard- 

213 

Potassii    iodidum. 

N. 

0.7 

12 

gr.  5-60 

0.30-4 

ening    of    plaster    of 
Paris. 
Bromide    is    a    nerve 

229 

Potassii   nitras, 

N. 

3.6 

aim. 

gr.  5-20 

0.30-1.30 

266 

nitre,   saltpetre. 

insol. 

sedative.      The   most 

140 

Potassii       perman- 

N. 

15 

decomp 

gr.  J^-2 

0.03-0.12 

efficient    remedy    in 

153 

ganas. 

epilepsy.      In  infan- 

Potassii sulphas. 

N. 

9 

insol. 

33^-4 

2-15 

tile    convulsions, 
headaches,       fevers, 
insomnia,      nervous- 
ness, hysteria.  Seda- 
tive to  sexual  organs. 
Iodide      is      alterative 
and  sialagogue.     Es- 
pecially  valuable   in 
tertiary  syphihs.    In 
asthma,           chronic 
bronchitis,      chronic 
rheumatism.  In  lead 
poisoning     to      pro- 
mote eUmination. 

Prepared  chalk.    See 

Cyanide  is  in   action 

under  Calcium. 

similar    to    hydrocy- 
anic acid. 
Permanganate    as 
antiseptic. 

142 

*Protargol,     a    pro- 
teid  compound  of 
silver. 

Prunus       Virginian  a 

sol. 

Antiseptic.  Applied 
in  1  to  5%  solutions. 

207 

3J^-l 

2-4 

Bitter  tonic.     Sedative 

(p.  serotina),  wild 

by  virtue  of  hydro- 

cherry bark. 

cyanic    acid,    which 

Fluidextractum 

iZVi-l 

2-4 

is   developed   in   the 

pruni  virginianae. 

cold       infusion.      In 

Infusum. 

f51-2 

30-60 

pulmonary   diseases, 

Syrupus. 

f3l-4 

4-15 

coughs,   dyspepsia. 

Prussic     acid.       See 

Acidum   hydro- 

cyanicum  dil. 

Pumpkin  seed.     See 

Pepo. 

Pyrethrum         (ana- 

5H-1 

2-4 

Sialagogue.      Irritant. 

cyclus  p.,  root). 

As  gargle.     As  snuff 

Tinctura  pyrethri. 

extern. 

in  chronic  catarrh. 

80 

Pyrogallol,    pyrogal- 
lic  acid. 
♦Ointment, 2  to  3% 

n'.  or 
ac. 

"i.6' 

.  .^.  . 

Caustic. 

Externally  in  skin 
diseases. 

111 

Pyroxylinum,       sol- 
uble guncotton. 

insol. 

t 

To  prepare  collodion 
and  celluloid. 

t  Soluble  in  25  parts  of  a  mixture  of  3  vols,  ether  with  1  vol.  alcohol. 


294 


mmx  OF  DRVGB 


Solubility  in 

Dose. 

Page 

in 

Drug. 

Reac- 

Gm. or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

Pyrozone.    See  Aqua 

hydrogenii  diox. 

205 

Quassia  (picrasma 
excelsa,  wood). 



Bitter  tonic.  Anthel- 
mintic.   In  atonic  in- 

Extractum quas- 

gr.  H-3 

0.03-0.20 

digestion    and    diar- 

siae. 

rhea.         Infusion   as 

Fluidextractum. 

f3M-i 

1-4 

enema     to     remove 

Tinctura. 

f3J^-2 

2-8 

thread-worms.    Con- 

♦Infusion. 

f5i-2 

30-60 

tains  no  tannin. 

Quercus,   white   oak 

Astringent.  Same  uses 

(bark). 

as  tannic  acid. 

Fluidextractum. 

f3M-l 

1-4 

206 

Quinina. 

al. 

1750 

0.6 

Quinine    is    the    chief 

Quininae  bisulphas. 

ac. 

8.5 

18 

remedy  used  in  ma- 

Quininae hydro- 

N. 

40 

0.67 

larial    fevers.       The 

bromidum. 

■gr.  1-^20 

0.06-1.30 

sulphate      is      used 

Qmninse  hydro- 

N. 

18 

0.6 

mostly,   but   the   bi- 

chloridum. 

sulphate      is      more 

Quininse  salicylas. 

al. 

77 

11 

soluble.    The  hydro- 

Quininae  sulphas. 

N. 

720 

861 

bromide  and  hydro- 

♦Compound      tinc- 

fo2-6 

8-25 

chloride   are    recom- 

ture   (Warburg's). 

mended     for     hypo- 

Red precipitate.   See 

dermic  use. 

Hydrargyri       oxi- 

dum  rubrum. 

Resina     (from     tur- 

insol. 

sol. 

In  plasters  and  oint- 

pentine), resin. 

ments. 

Ceratum        resinae, 

extern. 

Resin    cerate    is    ap- 

basilicon         oint- 

plied to  bruises,  ul- 

ment. 

cers,  etc. 

139 

Resorcinol,  resorcin. 

Rhamnus     frangula, 
buckthorn. 
See  Frangula. 

N. 

0.5 

0.5 

gr.  2-10 

0.12-0.60 

Antiseptic.  May  use 
internally.  In  per- 
tussis, 2%  solution 
used  as  a  spray  to 
the  upper  air  tract. 

Plate 

Rhamnus  purshiana, 

3M-1 

1-4 

Tonic    cathartic.       In 

XVIU. 

cascara       sagrada 
(bark). 
Fluidextractum 
rhamni  purshianae 
Rhatany.     See  Kra- 

foM-1 

1-4 

chronic  constipation. 

Plate 

Rheum,  rhubarb  (r. 

gr.  3-30 

0.20-2 

Astringent.    Cathartic. 

XVIU. 

officinale,  root). 

Small  doses  tonic  to 

Extractum    rhei. 

gr.  3-15 

0.20-1 

intestinal  tract.  Lar- 

Fluidextractum. 

f5M-l 

1-4 

ger   doses    safe,    effi- 

Mistura    rhei     et 

f5M-2 

8-60 

cient  laxative.  Cath- 

sodae. 

artic  effect  apt  to  be 

Pilulae  compositae. 

1-3  pills. 

followed    by    consti- 

Pulvis  compositus. 

3H-1 

2-4 

pation    unless    com- 

Syrupus. 

Syrupus    aromatic- 

::::[ 

child  31 

child  4 

bined    with    more 
powerful    agents,    as 

cus. 

in     compound     pill. 
Its   astringency 
makes  it  a  valuable 
laxative  in  diarrheas. 

Tinctura. 

f3l-4 

4-15 

Mixture  of  r.  and  soda 

Tinctura  aromatica 

f3l-3 

4-12 

is  antacid  and  laxa- 
tive. 

156 

*Rhigolene  (from  pe- 
troleum). 

Rochelle    salt.      See 
Potassii    et     sodii 
tartras. 

Used  as  local  anal- 
gesic. 

Rhus      glabra,      su- 

3J€-l 

1-4 

Astringent.      As   mild 

mach  (fruit). 

astringent,  gargle,  or 

Fluidextractum 

f3M-l 

1-4 

lotion. 

rhois  glabrae. 

*Rosa      damascena, 

damask  rose. 

Aqua  rosae. 

Rose  water.     As  ve- 

Aqua rosae  fortior. 

hicle  or  flavor. 

Unguentum     aquae 

Cold  cream  to  soften 

rosae,  cold  cream. 

the  skin.  Applied  to 
chapped  hands. 

256 

Oleum    rosae,    otto 
of  rose. 
Rosa      gallica,      red 
rose  (dried  petals). 
Confectio  rosae. 

N. 

insol. 

si.  sol. 

Flavoring  agent.  Per- 
fume. 

Flavoring  agent.  The 
confection  as  ex- 
cipient  in  pill  masses. 

INDEX  OF  DRUGS 


295 


Page 


31 
240 


32 


Drug. 


Reac- 
tion. 


Solubility  in 


Water    Alcohol 


30 
114 


216 


Fluidextractum. 
Mel.,  honey  of  rose. 
Syrupus. 

Rubus,    blackberry 

(bark  of  root"). 

Fluidextractum 

rubi. 
Syrupus. 

Saccharine.  oee 

Benzosulphinidum 
Saccharum,        cane- 
sugar. 
Syrupus. 
Saccharum        lactis, 
sugar  of  milk. 

Sage.     See  Salvia. 

Salicinum,  salicin 
(from  several  spe- 
cies of  salix  and 
populus). 

Salol.  See  phenyHs 
salicylas. 

Saltpetre.  See  Po 
tassii  nitras. 

Salvia  (s.  officinalis) 
sage  leaves. 

*Sandarach,  a  resin. 

Santoninum       (from 
santonica) ,       san- 
tonin. 
Trochisci  santonini. 

Sapo,   white   CastUe 
soap. 
Emplastrum         sa- 

ponis. 
Linimentum. 
Sapo      mollis,      soft 
soap,  green  soap. 


Linimentum    sapo- 

nis  mollis. 
Sarsaparilla  (root). 
Decoctum  sarsapa- 

rillse  comp. 
Fluidextractum. 
Fluidextractum 

comp. 
Syrupus  comp. 
Sassafras     (s.     varii- 

folium,     bark     of 

root). 
Oleum  sassafras. 
Plate  'Scammonium, 

resinous     product 

of  convolvulus  s. 

Resina    scammonii 

Scilla,    squill    (urgi- 

nea   maritima, 

bulb). 
Acetum  scillae. 
Fluidext  ractum. 
Syrupus. 
Syrupus         comp., 

hive  syrup   (0.2% 

tartar  emetic). 
Tinctura. 
Scopola    (s.    carnio- 

Uca,  root). 
Extractum  scopolse. 
Fluidext  ractum. 
Scopolaminae         hy- 

drobromidum. 
Seidlitz  powder.    See 

under   Potassii  et 

sodii  tartras. 


229 
232 


0.46 

h" 

21 


138 
insol. 

71 


Dose. 


insol. 
insol. 


al. 
al. 


sol. 
34 


insol. 


sol. 


Gm.  or 
c.c. 


Uses. 


■  f  51-2  ■ 


f3J^-2 
f31-2 


o^-l 
f51-4 


f3J^- 


gr.  5-30 


3^-1 


gr.  H-l 
child. 

gr.  H 
in  each, 
gr.  5-15 


f5J€-i 

3M-1 


ini-5 

gr.  2-10 


2-5 
1-5 


1-4 

freely. 

4-8 


2-8 
4-8 


indef. 


indef. 
indef. 


0.30-2 


1-4 


0.015-0.06 


0.03  in 
each. 
0.30-1 


Fluid  extract  _  and 
syrup  as  vehicles. 
The  honey  locally  as 
mouth-wash. 

Astringent.  In  diar- 
rheas. 


Sweetening   agent. 
Preservative. 

Syrup    as   vehicle. 

The  hardness  of  its 
particles  make  it 
useful  in  preparing 
triturations. 

Tonic.  Antiperiodic. 
In  rheumatism,  ma- 
larial fevers. 


Astringent.  Infusion 
as  gargle,  often  with 
alum. 

Used  as  a  varnish. 

Anthelmintic.  To  de- 
stroy round  worms, 
used  cautiously. 


nilO-45 

mi-5 

f3^-l 
TT15-30 


tTl5-30 


g.  Vio-J^ 

WA-2 

gr.  Vi80-^/60 


extern, 
extern. 


2-4 
30-120 


2-4 
2-4 


8-30 
1-4 


0.06-0.30 
0.12-0.60 


Seldom  internally  ex- 
cept in  suppository 
or  pUl.  Powdered, 
used  as  an  alkali  and 
detergent  in  denti- 
frices. Soft  soap  as 
antiseptic.  In  dis- 
eases of  the  skin. 

Tonic.  Alterative.  Has 
very  feeble  medi- 
cinal powers.  Used 
chiefly  as  vehicle 
for  stronger  altera- 
tives. 

The  warm  infusion  is 
diaphoretic.  Regard- 
ed as  alterative,  but 
has  feeble  power. 
Hydraqogue  cathartic. 
In  cerebral  disorders 
as    derivative.  In 

0.12-0.30       dropsies. 
0.06-0.30    Diuretic.  Expectorant. 
In  large  doses  emetic. 
Like       digitalis,      it 
0.60-3         strengthens        pulse 
0.06-0.30      and  increases  excre- 
2-4  tion     of     urine.      In 

0.30-2         bronchitis,        croup. 
The    compound 
syrup   cautiously 
0.30-2        with  children. 


0.006-0.03 

0.03-0.12 

0.0003-.001 


Similar  to  belladonna 

in  action. 
Mydriatic,  Resembles 

atropine    and    hyos- 

cyamine    in     action 

and  uses. 


296 


INDEX  OF  DRUGS 


Solubility  in 

Dose. 

Page 

Drug. 

Reac- 

in 

Gm.  or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

Senega  (polygala  s.. 

gr.  10-20 

0.60-1.30 

Stimulant  expectorant. 

root). 

Diuretic.    In  chronic 

Fluidextractum 

niio-20 

0.60-1.20 

bronchitis,     asthma, 

senegae. 

croup.      Often  com- 

Syrupus. 

f3l-2 

4-8 

bined  with  squill. 

Plate 

Senna    (cassia  acuti- 

31-3 

4-12 

Cathartic.        Efficient 

xviii. 

folia    and    c.     an- 
gustifoUa,  leaves). 

and  safe  in  any  con- 
dition, except  intes- 

Confectio sennae. 

51-2 

4-8 

tinal     inflammation. 

Fluidextractum. 

f51-3 

4-12 

The    confection    and 

Infusum  comp. 

f3i-2}^ 

30-75 

compound       licorice 

Pulvis    glycyrrhizae 

3J^-2 

2-8 

powder      are      mUd, 

compositus. 

useful     for     children 

Syrupus. 

f5M-i 

8-30 

and  in  pregnancy. 

Serum  antidiphtheri- 

In  diphtheria,    hypo- 

cum,   diphtheria 

dermically,    to      an- 

antitoxin. 

tagonize  poison  of 
the  disease. 

Sevum  prseparatum, 

insol. 

44 

extern. 

As    basis   for   cerates 

mutton  suet. 

boiUng 

and  ointments. 

61 

Sinapis    alba,    white 
mustard  seed. 

indef. 

Rubefacient.  Irritant 
emetic.           Mustard 

61 

Sinapis   nigra   (bras- 

extern. 

owes      its      irritant 

230 

sica   nigra),   black 
mustard  seed. 
Charta       sinapis, 
mustard  paper. 

extern. 

property  to  the  vola- 
tile oil,  which  is  de- 
veloped in  the  pres- 
ence of  cold  water. 

61 

Oleum  sinapis  vola- 

N. 

insol. 

sol. 

WA-K 

0.0075-.015 

The  volatile  oil  isara- 

135 

tile. 
*Flour  of  mustard 

is    a    mixture    of 

white  and  black. 
Slippery    elm.      See 

Ulmus. 
Soap.     See  Sapo. 
*Sodium,   a  metal. 

, 

tiseptic,  but  very  irri- 
tating. 

The     general     action 

Sodii  acetas. 

'al.' 

"i' " 

■  23  ' 

gV.  10-30 

"  6!66-2 ' 

and  uses  of  sodium 

Sodii  arsenas.     See 

salts    are   similar   to 

under  Arseni. 

those  of  potassium. 

Sodii  benzoas. 

N. 

1.6 

43 

gr.  5-30 

0.30-2 

As  alkalies  they  are 

115 

Sodii  bicarbonas. 

al. 

12 

insol. 

gr.  5-30 

0.30-2 

less    disturbing;    be- 

Trochisci sodii  bi- 

gr.  3  in 

0.20  in 

ing  better  tolerated 

carbonatis. 

each. 

each. 

by  the  system  they 

Sodii  bisulphis.  See 

are  more  slowly  eli- 

under   Acid,     sul- 

minated,      therefore 

phurosum. 

less  diuretic. 

115 

Sodii   boras,    borax 
(sod.   diborate). 

al. 

20.4 

insol. 

gr.  5-30 

0.30-2 

Liq.  sod.  hydrox.,  the 
acetate  and  carbon- 

123 

*Liquor    sodii    bo- 
ratis     compositus, 
Dobell's  solution. 

al. 

extern. 

ates  as  alkalies,  the 
bicarbonate  more 
than    all    others    for 

218 

Sodii  bromidum. 

N. 

1.7 

12.5 

gr.  6-60 

0.30-4 

internal  use. 

Sodii  carbonas 

al. 

2.9 

insol. 

gr.  5-15 

0.30-1 

Benzoate  and  borate 

monohydratus. 

are  antiseptic. _  _  The 

Sodii  chloras. 

N. 

1 

100 

gr.  5-15 

0.30-1 

former  in  cystitis,  to 

49 

Sodii        chloridum. 

N. 

2.8 

aim. 

gr.  5-60 

0.30-4 

prevent    decomposi- 

200 

common  salt. 

insol. 

tion  of  urine.  Borax 

152 

*Sodium  dioxide. 

al. 

sol. 

extern. 

as     mouth-wash    in 
thrush. 
Caustic. 

74 

Sodii    hydroxidum, 

al. 

1 

v.  s. 

1115-15 

0.30-1 

266 

caustic  soda. 
Liquor  sod.  hy- 
droxidi,  5.6  %. 

well 
diluted. 

Sodii  hypophosphis 

N. 

1 

25 

gr.  5-20 

0.30-1.30 

Bromide    is    sedative. 

213 

Sodii  iodidum. 

al. 

0.5 

3 

gr.  5-30 

0.30-2 

Large  doses  by  ene- 

Sodii nitras. 

N. 

1.1 

100 

gr.  5-30 

0.30-2 

ma    to    control   ob- 

Plate 

Sodii  nitris. 

al. 

1.4 

si.  sol. 

gr.  1-3 

0.06-0.20 

stinate  vomiting  due 

xiii. 

to  reflex  causes. 

Plate 

Sodii  phosphas. 

al. 

5.5 

insol. 

gr.  5-51 

0.30-30 

Chlorate    and    iodide 

xviii. 

Sodii  phenolsulpho- 
nas. 

N. 

-1.8 

130 

gr.  1-10 

0.06-0.60 

resemble  correspond- 
ing potassium  salts. 

Liquor    sod.    phos- 

f3l-4 

4-15 

Chloride     in     normal 

phatis  comp. 

(0.6%)    solution    as 

130 

Sodii  salicylas. 
*Sodium  silicate. 

ac. 

0.8 
boiling. 

5.5 

gr.  5-30 

0.30-2 

cleansing  lotion  in 
diphtheria,          nasal 

♦Liquor    sodii    sili- 

ai.' 

extern. 

catarrh,  pharyngitis, 

catis,    solution    of 

and_  hypodermically 

soluble  glass. 

or  intravenously  as 
restorative. 

INDEX  OF  DRUGS 


297 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Water   Alcohol 


Dose. 


Gm.  or 
c.c. 


Uses. 


Plate 
xviii. 


137 


267 


165 
193 

202 

Plates 

iv.,xi. 

266 


Sodii  sulphas,  Glau- 
ber's salt. 
Sodii    sulphis.     See 
under  Acidum 

sulphurosum. 
Sodii  et  potassii  tar- 
tras.     See  Potassii 
et  sodii  tartras. 
Sodii     thiosulphas 
(hyposulphite). 
See     under     Acid, 
sulphurosum. 

Soda  powders,  effer- 
vescing powders, 
consist  of  one 
powder  of  bicarbo- 
nate of  sodium 
and  one  of  tartaric 
acid,  taken  to- 
gether. 

*Sodium  tetraborate 
(neutral  sod.  bo- 
rate). 

Soluble  glass.  See 
under  Sodium. 

*Sozoiodol._  sozoio- 
dolic  acid,  53% 
iodine. 

Spanish  flies.  See 
Cantharis. 

Sparteine   sulphas 
(from  scoparius). 

Spearmint.       See 
Mentha  viridis. 

Spermaceti.     See 
Cetaceum. 

Spiritus  setheris  ni- 
trosi.  See  under 
^ther,  nitrous. 

Squill.     See  Scilla. 

Starch.  See  Amy- 
lum. 

Storax.    See  Styrax. 

Stramoii    foha    (da- 
tura s.,  leaves). 
Extractum        stra- 

monii. 
Fluidextractum. 
Tinctura. 
Unguentum. 
See  Daturine. 


Strophanthus  (s. 

Komb6,  seeds). 
Tinctura  stro- 

phanthi. 
Strophanthinum. 

Strychnina        (from 
nux  vomica). 

Strychninse  nitras. 
Strychninae     sul- 
phas. 

Styrax,  storax. 
Tinctura     benzoini 

composita,     8% 

storax. 
Suet.    See  Sevum. 
Sugar.        See      Sac 

charura. 
Sugar  of  lead.      See 

Plumbi  acetas. 
Sugar  of  milk.      See 

Saccharum  lactis. 


2.8 


insol. 


si.  sol. 


1.1 


2.4 


V.  s. 
6400 


42 
31 


insol. 


sol. 
110 


120 
65 


51-8 


gr.  3-10 


gr.  Vio-1 


gr.  1-5 
gr.  H-Vi 

mi-5 

ni5-30 


ms-io 

^/eoo-'/ioo 
grain. 


gr.  i/eo-Vio 
gr.  Veo-Vio 


gr.  5-20 
f3J^-l 


4-30 


0.20-0.60 


0.006-0.06 


0.06-0.30 

0.015-0.03 

0.06-0.30 
0.30-2 
extern. 


0.12-0.60 

.0001-.0006 

0.001-.006 


0.001-.006 
0.001-.006 


0.30-1.30 
2-4 


Dioxide  is  a  caustic 
and  bleaching  agent. 
In  saturated  solu- 
tion to  bleach  teeth. 

Hypophosphite  is 

tonic. 

Phosphate  and  sul- 
phate are  laxative. 

Nitrite  has  same  uses 
as  nitroglycerin. 

Salicylate  has  same 
uses  as  salicylic  acid. 

Liquor  sodii  silicatis, 
to  prepare  immov- 
able surg.  dressings. 

Phenolsulphonate  is 
used  internally  for 
same  purposes  as 
carbolic  acid. 

Antiseptic.  Same  uses 
as  boric  acid. 


Antiseptic.  In  solu- 
tion or  as  dusting 
powder. 


Heart  stimulant.  Diu- 
retic. Acts  more 
promptly  than  digi- 
talis. 


Narcotic.  A  nodyne. 
Leaves  used  as  fumi- 
gation in  asthma. 
General  action  sim- 
ilar to  that  of  bella- 
donna. As  antispas- 
modic and  anodyne 
in  asthma,  chorea, 
neuralgia,  dysmen- 
orrhea. Ointment  to 
painful  ulcers. 

Heart  stimulant.  Diu- 
retic. Effect  upon 
heart  similar  to  that 
of  digitalis.  Used  in 
cardiac  diseases, 

dropsy. 

Bitter  tonic.  Nerve 
stimulant.  Action 
and  uses  same  as 
those  of  nux  vom- 
ica, which  drug  it 
represents  fully. 

Expectorant.  A  nti- 
septic.  Tn  catarrhs, 
purulent  mucous 

discharges.     To  pre- 
serve fats. 


^98 


tNDlSX  OF  DRUGS 


Solubility  in 

Dose. 

Page 

in 

Drug. 

Reac- 

Gm. or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

225 

Sulphonethylmeth- 
anum,  trional. 

N. 

195 

V.  s. 

gr.  5-30 

0.30-2  I 

Hypnotic.  Both  are 
less      depressing, 

225 

Sulphonmethanum, 
sulphonal. 

N. 

360 

47 

gr.  5-30 

0.30-2  j 

therefore  safer,  than 
chloral. 

Plate 

Sulphur  lotum, 

N.  1 

sl.sol.in 
abso- 
lute al- 
cohol. 

~ 

Laxative.      Alterative. 

xviii. 

washed  sulphur. 

In    chronic    eczema. 

S.  praecipitatum. 

insol. 

i  ohi-1 

1-4 

psoriasis,   and   other 

S.  subUmatum, 

ac. 

1 

skin   diseases,   inter- 

flowers of  sulphur. 

J 

nally  and  externally. 

Unguentum         sul- 

extern. 

Very  effectual  exter- 

phuris, 15%. 

nally     for      scabies. 

Sulphuris  iodidum. 

ac. 

aim. 
insol. 

t 

gr.   1-4 

0.06-0.25 

Washed  s.  most  suit- 
able for  internal  use. 

Sulphuric  ether.    See 

The  iodide  is  used  in 

JSther,  ethylic. 

scrofulous      diseases 

Sumach.     See  Rhus 

of  the  skin. 

glabra. 

*Svapnia,  a  purified 

sol. 

sol. 

Dose   and   uses   same 

opium. 

as  opium. 

Sweet  almond.     See 

Amygdala  dulcis. 

Sweet  birch  oil.    See 

Oleum  betulse. 

Sweet  flag.    See  Cal- 

amus. 

Sweet        spirit        of 

nitre.     See     under 

JEther,   nitrous. 

Syrup   of  hypophos- 

phites.    See  Hypo- 

phosphites. 

267 

*Tabacum,     tobacco 
(nicotiana  t.,  Ivs.) 
See  Nicotine. 

gr.  1-5 

0.06-0.30 

Emetic  sedative.  De- 
pressing and  danger- 
ous.    Seldom  used. 

Tamarindus,     tam- 

ac. 

freely. 

Laxative.      In  confec- 

arind   (t.    indica, 

tion  of  senna.     Also 

fruit). 

in  infusion  as  acidu- 
lous drink  in  fevers. 

*Tanacetum,     tansy 

o>€-l 

1-4 

Emmenagogue.       An- 

(t. vulgare,  leaves 

thelmintic.      Danger- 

and tops). 

ous  in  large  doses. 

*Volatile  oil. 

1111-3 

0.06-0.20 

Tar.  See  Pix  Uquida. 

Tartar    emetic.     See 

Antimonii    et    po- 

tassii  tartras. 

Terebenum      (from 

N. 

si.  sol. 

3 

n[5-15 

0.30-1 

Stimulant  expectorant. 

turpentine). 

In     cough,     chronic 

Terebinthina,       tur- 

ac. 

insol. 

sol. 

bronchitis,   hay 

pentine,    an    oleo- 

asthma. 

resin  from  pine. 

135 

Oleum  terebin- 

N.  or 

insol. 

3 

irn5-30 

2-15 

Anthelmintic. 

thinse. 

si.  ac. 

0.30-2 

Stimulant.       Diuretic. 

230 

Oleum   t.   rectifica- 
tum. 

N. 

insol. 

3 

Externally  vesicant. 
Internally      in  _  ty- 

Emulsum olei  tere- 

f  5 1^-2 

2-8 

phoid         conditions, 

binthinse,  15%. 

chronic       inflamma- 

62 

Linimentum,  35%. 

Terebinthina     cana- 
densis,  balsam    of 
fir.      Canada    bal- 
sam. 

extern. 

tions       of       mucous 
membranes,       intes- 
tinal ulceration  and 
hemorrhages.        The 
crude   French   oil  in 
phosphorus     poison- 
ing. 
Used  in  mounting  mi- 
croscopic sections. 

Terpini  hydras,  ter- 

N. 

200 

10 

gr.  2-10 

0.12-0.60 

Antiseptic.      Expecto- 

pin hydrate. 

rant.     In  bronchitis. 

*Terpinol. 

insol. 

sol. 

rn5-i5 

0.30-1 

Same  uses  as  above. 

*Tetronal. 

450 

sol. 

gr.  15-30 

1-2 

Hypnotic. 

*Theobroma    cacao. 

To  prepare  chocolate. 

(seeds). 

31 

Oleum         theobro- 
matis,  cacao  but- 
ter. 

N. 

insol. 

100 

In  preparing  supposi- 
tories. 

t  Alcohol  dissolves  out  iodine. 


INDEX  OF  DRUGB 


299 


Page 
in 
text. 

Solubility  in 

Dose. 

Drug. 

Reac- 
tion. 

Water 

Alcohol 

Gm.  or 

CO. 

Uses. 

202 

♦Theobromine. 

si.  sol. 

sol. 

gr.  2-10 

0.12-0.60 

Diuretic.     Similar     to 

♦Theobromine     sali- 

si. sol. 

gr.  2-10 

0.12-0.60 

caffeine. butless  stim- 

cylate. 

ulating  to  cerebrum. 

♦Theobromine      and 

sol. 

gr.  15 

1 

Recommended  as  diu- 

sodium salicylate, 

retic. 

diuretin. 

♦Thymus      vulgaris, 

3M-1 

1-4 

Aromatic       stimulant. 

thyme   (leaves). 

Mostly    as    infusion. 

135 

Oleum  thymi. 

N. 

in  sol. 

0.5 

nii-5 

0.06-0.30 

Oil    as   carm.inative. 

135 

Thymol. 

1100 

1 

gr.  1-8 

0.06-0.50 

Antiseptic. 

135 

ThymoHs   iodidum, 
aristol,46%  iodine. 

insol. 

675 

extern. 

Antiseptic.  Substitute 
for  iodoform. 

Tragacantha,       gum 

part. 

insol. 

Excipient    in    making 

tragacanth. 

pOls      and      troches. 

MucUago          traga- 

freely. 

Mucilage  as  vehicle. 

cantha;. 

Trional.     See  S'olph- 

onethylmethanum 

Tully's  powder.    See 

under  Morphina. 

169 

♦Tropacocaine      hy- 
drochloride   (from 
"small-leaved 
coca"). 

Turpentine.          *See 
Terebinthina. 

al. 

sol. 

sol. 

gr.  M-1 

0.015-0.06 

Local  anesthetic.  Sim- 
ilar to  cocaine,  but 
less  toxic. 

90 

Ulmus     (u.     fulva) , 

Demulcerd.  Emollient. 

sUppery    elm    (in- 

As   poultice.     Inter- 

ner bark). 

nally  in  pharyngitis. 

MucUago  ulmi. 

freely. 

diarrhea,   dysentery. 

♦Decoction. 

freely. 

cystitis,  irritation  of 

Urotropin.     <See 

" 

luinary  tract. 

Hexamethyl- 

enamina. 

230 

Uva  ursi,   bearberry 
(arctostaphylos  u. 
u.,  leaves). 
Fluidextractum 
uvse  ursi. 

oM-1 
foM-1 

1-4 
1-4 

Astringent.  Diuretic. 
In  chronic  disorders 
of  urinary  tract. 

Valeriana,  valerian 

gr.  10-30 

0.60-2 

Stimulant.     Antispas- 

(v. officinalis, 

modic.     In  hysteria, 

root). 

chorea,     and     other 

Fluidextractum 

tniO-30 

0.60-2 

functional      nervous 

Valerianae.          • 

disorders,            head- 

Tinctura. 

iZV2-2. 

2-8 

aches.      In    typhoid 

Tinctura        ammo- 

f3J^-2 

2-8 

conditions. 

niata. 

Vanilla     (v.     plani- 

) 

folia,  fruit). 

y... 

Flavoring  agent. 

Tinctura  vanillae. 

) 

Vaseline.    See  Petro- 

latum. 

Veratrina           (from 

al. 

si.  sol. 

2.2 

gr.  i/30-''/io 

0.002-0.006 

Has    been    employed 

sabadilla) . 

externally     in     neu- 

Oleatum veratrinae. 

extern. 

ralgia    and    rheuma- 

2%. 

tism,  but  rarely  used 

Unguentum,  4%. 

extern. 

internally. 

218 

Veratrum,  Am.  helle- 
bore  (root). 

■gr.i-s' 

0.06-0.30 

Sedative.  In  action 
similar    to     aconite. 

Fluidextractum 

TTll-5 

0.06-0.30 

In     sthenic     fevers. 

veratri. 

mania,          puerperal 

Tinctura. 

ni5-20 

0.30-1.20 

convulsions. 

Viburnum         pruni- 

3M-1 

1-4 

Tonic.     Uterine  seda- 

folium, black  haw 

tive.      Used    to    pre- 

(bark). 

vent    abortion.      In 

Fluidextractum 

f3M-l 

1-4 

dysmenorrhea. 

viburni  prunifolii. 

Vienna    paste.      <See 

under  Potassium. 

34 

Vinum  album,  white 
wine. 

ac. 

Stimulant.  Wines  de- 
pend      largely     _  for 

34 

Vinum  rubrum,   red 
wine    (each     con- 
tains 8.5   to    15% 
by    vol.    absolute 
alcohol). 

their  medicinal 
value  upon  the  alco- 
hol they  contain. 

300 


INDEX  OP  DRUG^ 


Solubility  in 

Dose. 

Page 

Drug. 

Reac- 

in 

Gm.  or 
c.c. 

Uses. 

text. 

tion. 

Water 

Alcohol 

Warburg's    tincture. 

Zinc  salts  are  astrin- 

See under  Quinine. 

gent,    and     in    large 

Wax.     See  Cera. 

doses   irritant.      Sul- 

Whiskey. See  under 

phate     and     aretate 

Alcohol. 

are  most  valuable  as 

White  oak.    See 

astringents.    In  weak 

Quercus. 

solution  to  inflamed 

White       precipitate. 

mucous  membranes, 

See  Hydrargyrum 

conjunctivitis,     ure- 

ammoniatum. 

thritis,  vaginitis,  ca- 

Wild    cherry.       See 

tarrhs,  etc.    In  large 

Prunus  virginiana. 

doses  they  are  emetic 

Wintergreen.         See 

the  sulphate  being  a 

Gaultheria. 

mild,    efficient,    and 

Witch-hazel.          See 

prompt     emetic     for 

Hamamelis. 

any    age.      Oxide   is 

Wood  spirit.  See  Al- 

used externally  as  a 

cohol,   methyl. 

sedative   to    wounds, 

Wood  tar.    <See  Pix. 

ulcers    and    in    dis- 

Yellow   wash.      See 

eases   of   the   skin. 

under     Hydrar- 

Chloride  is  a  powerful 

gyrum. 

escharotic    and    anti- 

Zincum,   zinc,    a 

septic. 

metal. 

ac. 

2.5 

34 

gr.  M-2 

0.03-0.12 

Bromide,     phosphide. 

Zinci  acetas. 

si.  ac. 

V.  s. 

V.  .s. 

gr.  1-5 

0.06-0.30 

and    valerate    have 

Zinci  bromidum. 

ac. 

0.3 

V.  s. 

extern. 

properties      of      the 

81 

Zinci  chloridum. 

ac. 

extern. 

combined  substances 

105 

Liquor  zinci  chlo- 

Iodide  is  used  mostly 

141 

ridi,  50%. 

as  an  alterative  exter- 

267 

nal  remedy.    May  be 

105 

Zinci  iodidum. 

ac. 

V.  s. 

_v.  s. 

gr.  1-3 

0.06-0.20 

used  in  cleaning  teeth 

Zinci  oxidum. 

insol. 

insol. 

gr.  1-5 

0.06-0.30 

and  in  gingivitis. 

Unguent  um  zinci 

extern. 

oxicli,  20  %. 

Zinci  phenolsulpho- 

ac. 

1.7 

1.7 

gr.  1-3 

0.06-0.18 

nas. 
*Zinci    phosphidum. 

insol. 

insol. 

gr.  i/,o-i/3 

0.006-0.02 

105 
231 

Zinci  sulphas. 

ac. 

0.53 

insol.  j 

gr.  H-2 
gr.  10-30 

0.03-0.12 
0.60-2 

Astringent. 
Em  etic. 

Zinci  valeras. 

ac. 

50 

35 

gr.  J^-3 

0.03-0.20 

Zingiber,    ginger    (z. 

gr.  5-15 

0.30-1 

Aromatic      stimulant. 

officinale,  root). 

Condiment.     As  car- 

Fluidextractum 

Tn5-15 

0.30-1 

minative     in     flatu- 

zingiberis. 

lence.      Mild   stimu- 

Syrupus. 

f5H-2 

2-8 

lant  in  atonic  indi- 

Tinctura. 

f3M-l 

1-4 

gestion.     The  syrup 
as  vehicle. 

GENERAL  INDEX. 


A.  C.  E.  MIXTURE,   192 

Abbreviations,  259 
Abortive  poisons,  261 
Abscess,  65,  147 
alveolar,  76 
Absorption  of  medicines,  43,  44,  48 
Acacia,  90,  269 
Acetanilid,  137,  219,  269 

compound  powder  of,  219 
poisonous  effects  of,  219 
Acetozone,  152,  269 
Acetphenetidinum,  219,  269 
Acetum,  24 
Acid,  acetic,  24,  269 

glacial,  72,  269 
arsenous.     See  Arsenic, 
benzoic,  129,  258,  269 
boracic,  122,  269 
boric,  122,  269 

carbolic,  74,  123,  126,  262,  291 
as  antiseptic,  123 
as  caustic,  74 
poisoning,  76,  124,  262 
chromic,  80,  269 
cinnamic,  129,  269 
citric,  209,  269 
gallic,  107,  269 
hydrochloric,  71,  262,  270 

dilute,  208 
hydrocyanic,  207,  262,  270 

dilute,  218,  270 
lactic,  73,  270 
nitric,  71,  262,  270 

dilute,  208 
nitrohydrochloric,  71,  270 

dilute,  209 
oxalic,  262,  270 
phosphoric,  dilute,  210,  270 
prussic,  262 
pyrogallic,  80,  293 
salicyUc,  129,  258,  270 
sulphuric,  71,  262,  270 
aromatic,  209,  270 
dilute,  209 
sulphurous,  153,  270 
tannic,  96,  244,  270 
glycerite  of,  93 
tartaric,  209,  270 
trichloracetic,  73,  270 
Acids,  mineral,  71,  262 

poisoning  by,  72,  262 


Acids,  mineral,  dilute,  208 

organic,  72 

vegetable,  209 
Aconite,  108,  218,  262,  270,  Plate  XIV. 

antagonists  to,  246 

tincture  of,  64,  65,  222 
Action  of  medicines,  19,  51 

chemical,  53,  70,  150 
electrical,  52 
physical,  51 
Actol,  142,  273 
Actual  cautery,  88 
Adeps  lana;,  91,  271 
Adjectives,  declensions  of,  250 
Administration  of  medicines,  42 
Adrenalin,  107,  166,  271 

as  an  aid  to  cocaine,  164 
^ther,  173,  185,  271.     See  Ether. 
^thyhs  chloridum,  156,  188,  271 
Air  embolism,  46 
Albolene,  90 
Albumin,  90,  271 

as  antidote,  76 
Alcohol,  ethylic,  98,  127,  193,  197,  271, 
Plate  VIII. 

absolute,  98 

as  antidote,  77 

as  astringent,  98 

as  preservative,  241 

as  solvent,  100,  240 

as  stimulant,  166,  197 

germicidal  power  of,  127,  138 

methyhc,  100,  271 
Alkahes,  112 

caustic,  73 
Alkaloids,  35 

artificial,  36 

of  opium,  35,  225 
Aloes,  271,  Plate  XVIII. 
Aloin,  37,  271,  Plate  XVIII. 
Alteratives,  40,  211 
Alum,  102,  271 

as  emetic,  231 

burnt,  80,  103,  271 
Alumen,  102,  271 

exsiccatum,  80,  103,  271 
Alveolar  abscess,  76.     See  Abscess. 
Alypin,  158,  170 
Ammonia,  50,  198,  262,  272 

spirit  of,  166,  198,  272 

aromatic,  166,  193,  198,  272 

water  of,  198,  272 

stronger,  73,  262,  272 
(301) 


302 


GENERAL  INDEX. 


Ammonium  bromide,  218,  272,  Plate  XV. 

carbonate,  199,  232,  262,  272 

chloride,  91,  232,  272 
Amygdalin,  37,  207 

Amyl  nitrite,  203,  265,  272,  Plate  XIII. 
Analgesia,  155 
Analgesics,  40,  155 

local,  155 

paralyzant,  156,  158 

refrigerant,  156 
Anesthesia,  155,  174 

asphyxia,  181,  192 

at  night,  182 

autointoxication  in,  181 

contraindications  to,  180 

dangers  of,  178 

local,  155 

mode  of  induction,  174 

precautions  concerning,  182 

preparation  of  patient  for,  181 

recovery  from,  180 

responsibility  in,  183 

resuscitation  from,  192 

stages  of,  175 
Anesthetics,  41,  155,  173 

action  of,  174,  Plate  V. 

comparative  safety  of,  190 

history  of,  173 

mixtures  of,  191 

responsibility  for  use  of,  183 
Animal  charcoal,  145,  277 
purified,  145,  277 
Anodyne,  41,  86 
Antacids,  40,  112 
Antagonism  of  drugs,  245,  246 
Antagonists  to  cocain,  164,  246,  Plate  IV. 
Anthelmintic,  41 
Antidote,  physiologic,  245 
Antidotes,  chemical,  70,  72.     See  Table 

of  Poisons  and  Antidotes. 
Antimonii  et  potassii  tartras,  231,  272 
Antipyretics,  41,  219 
Antipyrine,  106,  219,  224,  272 
Antiseptic  solution,  122 
Antiseptics,  40,  41,  120 
Antiseptol,  137,  272 
Antispasmodic,  41 
Antitoxin,  41,  54,  260,  272 
Aphthous  stomatitis,  139 

ulcers,  76 
Apomorphine,  35,  231,  273 
Apothecaries'  weights,  251 
Aqua,  24 

ammoniee,  198,  272 

fortior,  73,  262,  272 

cinnamomi,  133 

creosoti,  126,  258,  280 

fortis,  71 

hydrogenii  dioxidi,  107,  146,  273 

regia,  71 
Argenti  citras,  142,  273 

lactas,  142,  273 

nitras,  78,  141,  267,  273 
dilutus,  78,  273 
fusus,  78,  273 


Argyria,  78,  142 
Aristol,  135,  299 
Arsenic,  82,  211,  262,  273 

as  alterative,  211 

action  of,  84 

as  devitalizer,  83 

as  escharotic,  82 

combinations  with,  85 

poisoning  by,  88,    262 
local,  87 

rules  for  applying,  84 

trioxide,  82,  211,  273 
Arsenic-acid  anilide,  88 
Arsenous  acid,  82,  211,  262,  273 

solution  of,  211 
Artificial  alkaloids,  36 

respiration,  167,  192 

Howard  method,  168 
Laborde  method,  168 
Sylvester  method,  167 
Asepsis,  121 
Asphyxia,  181,  192,  261 
Asthenia,  261 
Astringents,  40,  94 

coagulant,  96 

mineral,  100 

vascular,  106 

vegetable,  96 
Atoxyl,  88 

Atropine,  35,   165,   193,  201,  262,  273, 
Plate  IX. 

antagonists  to,  246 

in  mercurialism,  144 

B. 

Balsamic  resins,  30 

Balsams,  30 

Belladonna,  201,  274,  Plate  IX. 

in  mercurialism,  144 
Benzin,  241,  274 
Benzoic  acid,  129,  258,  269 
Benzoin,  128,  274 

tincture  of,  128,  274 

compound,  128,  274 
Benzosulphinidum,  256,  275 
Benzoylacetyl  peroxide,  152,  269 
Benzozone,  152,  269 
Betanaphthol,  138,  275 
Biborate  of  sodium.     See  Borax. 
Bicarbonate  of  sodivim,  115,  296 
Bichloride  of  mercury,  142,  212,  264,  285 
Bisulphide  of  carbon,  277 
Bitter  tonics,  44,  205 
Black's  "1-2-3"  mixture,  132 
Bleaching  agents,  40,  150 

action  of,  150 
Blindness  of  infants,  141 
Blistering  agents,  59 
Blisters,  treatment  of,  68 
Bloodletting,  local,  56 

general,  57 
Blue  mass,  28,  212,  285 

ointment,  212,  285 

pill,  28,  212,  285 


GENERAL  INDEX. 


303 


Blue  vitriol,  80,  104,  264 

Boracic  acid,  122 

Borate  of  sodium,  115,  123,  258,  269 

neutral,  297 
Borax,  115,  123,  258,  269 
Boric  acid,  122,  269 
Borine,  138 

Boroglycerin,  glycerite  of,  122,  275 
Borolyptol,  138 
Bougies,  31 
Boulton's  solution,  64 
Bowel,  medication  by,  44 
Brandy,  98,  271 
Bromides,  218,  223,  Plate  XV. 

antagonists  to,  246 
Bromine,  80,  136,  262,  275 
Brow  ague,  206 
Brugg's  mixture,  192 
Bucliu,  230,  275 

Burnett's  disinfecting  fluid,  82,  267 
Burnt  alum,  80,  103 
Butylcliloral,  225,  278 


Cacao  butter,  31,  298 

Caffeine,  165,  193,  201,  230,  275,  Plate  X. 

antagonists  to,  246 

citrated,  165 
Caffeine-sodium  benzoate,  165 
Caffeine-sodium  salicylate,  165 
Cajuput,  oil  of,  134,  290 
Cajuputol,  134 
Calcined  magnesia,  116,  288 
Calcium  cliloride,  109,  276 

lactate,  109 
Calomel,  212,  285 
Calumba,  205,  275 
Calx  chlorinata,  136,  151,  278 
Campho-phenique,  77 
Camphor,  199,  263,  276 

spirit  of,  200 
Camphorated  oil,  276 

phenol,  77 
Canker  sores,  76 
Cannabis  indica,  263,  276 
Cantharidal  collodion,  67,  277 
Cantharides,  67,  263,  277 

preparations  of,  67,  277 
Capsicum,  61,  277 

tincture  of,  61 
Carbo  animalis,  145,  277 

purificatus,  145,  277 

ligni,  145,  256,  277 
CarboUc  acid,  74,  123,  291 
gangrene,  124 
poisoning,  76,  124,  262 
from  local  use,  77 
Carbon  disulphide,  277 
Carbonic  oxide,  263 
Care  of  mouth  during  pregnancy,  235 
Caries  in  deciduous  teeth,  nitrate  of  silver 
in,  79 

in  pregnancy,  235 
Cai-ron  oil,  68,  90,  276 


Cascara  sagrada,  294,  Plate  XVIII. 
Cassia,  oil  of,  132 
Castor  oil,  28,  290,  Plate  XVIII. 
beans,  263 

in  first  dentition,  223,  224 
Cataphoresis,  48,  64 
Cataplasm,  91 
Catechu,  97.     See  Gambir. 
Cathartics,  41,  228,  Plate  XVIII. 
Caustic  alkalies,  73 
lunar,  78,  273 
mitigated,  78,  273 
potash,  74,  266,  293 

pyrozone,  80,  146,  152,  273 

soda,  74,  266,  296 
Caustics,  40,  59,  70 
Cautery,  actual,  88 

galvano-,  89 

thermo-,  89 
Cayenne  pepper,  61,  277 
Cerates,  24 

Chalk,  prepared,  117,  276 
Chapped  hands,  92 
Charcoal,  145,  256,  277 

animal,  145,  277 

purified,  145,  277 
Charta,  24 

sinapis,  62 
Chemical  affinities  of  corrosives,  70 
Chloral  hydrate,  224,     225,     263,     278, 
Plate,_XVI. 

antagonists  to,  246 

phenol,  78 
Chlorate  of  potassium,  139,  266,  293 
Chloride  of  ethyl,  156,  188,  271 

of  zinc,  81,  105,  141,  267,  300 
Chlorinated  lime,  136,  151,  278 
Chlorine,  136,  151,  278 

bleaching  agents,  151 

preparations,  136,  278 
Chloroform     as     anesthetic,     186,    278, 
Plate  VII. 

antagonists  to,  246 

as  anodyne,  187 

as  irritant,  68,  188 

contraindications  to,  180 

dangers  of,  179,  180,  186,  263 

general  uses  of,  187,  188 

history  of,  173 

in  convulsions,  224 

inhaler,  187 

preparations  of,  278 
Cholagogues,  Plate  XVIII. 
Chromic  acid,  80,  278 
Chromium  trioxide,  80,  278 
Churchill's  iodine  caustic,  64 

tincture  of  iodine,  64 
Cinchona,  206,  278 
Cinchonine,  35,  278 
Cinchonism,  206 
Cineol,  134 

Cinnamic  aldehyde,  132,  133 
Cinnamon,  oil  of,  132,  279 

water,  133 
Cloves,  oil  of,  131,  132,  133,  277 


304 


GENERAL  INDEX. 


Coagulant  astringents,  96 

Coagulation  of  blood,  agents  that  favor, 

108,  109 
Cobalt  as  escharotic,  88,  279 
Coca,  158,  200,  279,  Plates  II.  and  III. 
Cocaine,  35,  158,  279 

aids  to  action  of,  164 

antagonists  to,  164,  246,  Plate  IV. 

dangers  of,  158,  161 

general  action.  Plates  II  and  III. 

habit,  48,  159 

hydrocliloride,  86,  107,  158,  279 

local  action  of,  159,  160 

poisoning,  cases  of,  161,  166 

Schleich  method  of  using,  162 

solutions  of,  160,  161,  243 

substitutes  for,  169 
Cocainization  of  spinal  cord,  171 
Codeine,  35,  227,  265,  279 
Cod-liver  oil,  210,  290 
Coffee,  97,  275 
Colchicum,  216,  279 
Cold  as  analgesic,  156 

as  hemostatic,  96 

as  sedative,  217 
Collodion,  24,  111,  279 

cantharidal,  24,  67,  279 

flexible,  24,  111,  279 

styptic,  24,  111,  279 
Columbo,  205,  275 
Coma,  261 

Combinations  of  drugs,  objects  of,  239 
Commercial  preparations,  138 
Compound  solution  of  iodine,  65,  286 

spirit  of  ether,  198,  271 

tincture  of  benzoin,  128,  274 
Constituents  of  drugs,  34 
Contraindications,  definition,  20 

to  chloroform,  180 

to  ether,  181 

to  nitrous  oxide,  180 
Convallaria,  203,  229,  280 
Convulsions  during  dentition,  223 
Copperas,  101 
Copper  salts,  poisoning  by,  263 

sulphate,  80,  104,  231,  280 

chemical  affinities  of,  70 
Corrosive  subfimate,  142,  212,  264,  285 

poisoning,  143,  144 
Corrosives,  70,  261 
Counterirritants,  59 

degree  of  action,  59 

modes  of  action,  60 

rules  for  applying,  60 
Court-plaster,  25 
Cowling's  rule,  247 
Cream  of  tartar,  229 
Crede's  method,  141 
Creosote,  67,  125,  131,  132,  264,  280 
Cresol,  125,  280 
Creta  prseparata,  117,  276 
Croton  oil,  28,  58,  66,  264,  290 
Cubeb,  91,  230,  232,  280 
Cubic  centimeter,  252 
Cumulative  effect,  19 


Cupping,  dry,  55 

wet,  55 
Cupri  sulphas,  80,  104,  231,  264,  280 

D. 

Death,  modes  of,  261 

signs  of,  261 
Deciduous  teeth,  phenol  in,  76 

silver  nitrate  in,  79 
Decoctions,  25 

Decolorized  tincture  of  iodine,  66 
Demvdcents,  40,  90 
Dentifrices,  254 

Dentine,  sensitiveness  of,  76,  81,  117 
Dentition,  first,  220 

complications  of,  220 
convulsions  during,  223 
lancing  of  gums  in,  56,  225 
Deodorant,  120,  145 
Depletion,  general,  57 
Depletives,  39,  55 

as  sedatives,  218 
Derivative  action,  60 
Detergents,  40,  112 
Devitalizers,  arsenic,  83 

phenol,  76 
Devitalizing  fibre,  86 
Diagnosis,  definition,  20 
Dialyzed  iron,  88,  282 
Diaphoretics,  41,  228,  230 
Digestant,  41 

Digitahs,  166,  193,  202,  229,  280,  Plate 
XII. 

antagonists  to,  246 

cumulative  effect  of,  20 
Diluents,  118 

Dioxide  of   hydrogen,  80,  107,  138,  146, 
151,273 

sodium,  152,  296 

sulphur,  153 
Disinfectant,  120 
Dispensatory,  definition  of,  18 
Dissociation  of  drugs,  52 
Dissolution,  20 
Diuretics,  41,  228,  229 
Dobell's  solutioii,  123 
Donovan's  solution,  211,  273 
Dosage  by  rectum,  45 

for  children,  247 

hypodermic,  45 
Doses,  247 

Dover's  powder,  238,  290 
Drastics,  Plate  XVIII. 
Drop  method  for  ether,  186 
Drug,  definition  of,  21 

habit,  48,  159,  226 
Drugs,  chemical,  21 

classes  of,  21 

constituents  of,  34 

effects  of,  19 

index  of,  269 

modes  of  action  of,  51 

official,  18 

organic,  21,  22 


GENERAL  INDEX. 


305 


E. 

Effects  of  drugs,  19 
Elastica,  281 

Elaterin,  37,  264,  281,  Plate  XVIII. 
Elimination  of  drugs,  44 
Eliminatives,  228 
Elixirs,  25 

Emetics,  41,  228,  230 
Emetine,  35,  281 
Emollients,  40,  90 
Emplastrum,  25 
Emulsin,  207 
Emulsions,  25,  210 
Endermic  method,  45 
Epidermic  method,  45 
Epinephrine,  107,  271 
Epispastics,  40,  59 
Ergot,  108,  281,  Plate  I. 
Errhine,  41 

Erythroxylon  coca,  158 
Escharotics,  40,  59,  70 
mode  of  action,  70 
Esmarch  inhaler,  187 
Ether,  ethylic,  173,  185,  198,  264,  271 

antagonists  to,  246 

as  anesthetic,  185,  Plate  VI. 

as  stimulant,  198 

contraindications  to,  181 

drop  method,  186 

explosiveness  of  vapor,  183 

general  uses  of,  186,  198 

history  of,  173 

inhaler,  185 

spirit  of,  198,  271 

compound,  198,  271 

spray,  156 
nitrous,  spirit  of,  222,  230,  271 
Ethyl  bromide,  192 

chloride,  156,  188,  271 

as  general  anesthetic,  188 

as  local  analgesic,  157 

deaths  from,  189 

inhaler,  189 

safety  of,  188 

spray,  156,  157 
Eucaine  hydrochloride,  158,  169,  281 
Eucalyptol,  134,  281 
Eucalyptus,  oil  of,  132,  134,  281 
Eugenol,  133,  134,  281 
Expectorants,  41,  90,  231 
Experiments,  70,  75 
Extracts,  26 

ethereal,  28 
fluid,  26 

F. 

Fats,  29,  91 

Ferric  chloride,  tincture  of,  101,  282 

solution  of,  101,  282 
Fern  hydroxidum,  87,  208,  262,  282 

cum  magnesii  oxido,  208,  262, 
282 
subsulphas,  liquor,  102,  282 
sulphas,  101,  264,  282 


Ferri  sulphas  exsiccatus,  101,  282 
tersulphatis,  liquor,  102,  282 

Ferrous  sulphate,  101,  264,  282 
dried,  101,  282 

Ferrum,  208,  282 

First  dentition.     See  Dentition. 

Flavoring  agents,  256 

Flaxseed,  91,  287 

Fluidextracts,  26 

Formaldehyde,  148,  283 

Formalin,  131,  132,  148,  264,  283 

germicidal  power  of,  132,  138,  149 

Formulary,  National,  18 

Formulas,  definitions  of,  238. 

Foul  breath,  129 

Fowler's  solution,  211,  273 

Frangula,  283,  Plate  XVIII. 

Freezing  mixture,  156 
spray,  157 

Fungi,  poisoning  by,  264 

G. 

Galenical  preparations,  23 
Galla,  97,  283 
GaUic  acid,  107,  269 
Galvanocautery,  89 
Gambir,  97,  283 

Gaultheria,  oil  of,  131,  132,  255,  283 
Gelatin,  109,  283 

General  remedies,  definitions  of,  40 
Gentian,  205,  283 
Germicide,  120 

Gingivitis,  interstitial,  106.     See   Pyor- 
rhoea alveolaris. 
Glacial  acetic  acid,  72,  269 
Glonoin.     See  Nitroglycerin. 
Glucosides,  37 
Glycerin,  92,  241,  244,  283 
Glycerite  of  boroglycerin,  122,  275 

of  tannic  acid,  93 
Glycerites,  27 
Glycothymoline,  138 
Glycyrrhiza,  91,  283 
Glycyrrhizin,  37,  284 
Gold  and  sodium  chloride,  274 
Gonococcus,  141 
Goulard's  extract,  105,  292 
Gout,  118 
Gram,  252 
Granular  eyelids,  80 
Green  vitriol,  101 
Guaiacol,  126,  280 
Guaiacum,  216,  284 
Gums,  lancing  of,  56,  225 
Gun  cotton,  293 


Habit,  drug,  35,  48 
Hffimatoxylon,  97,  284 
Halogens,  136 
Hamamelis,  97,  284 
Heart  during  anesthesia,  179,  186,  192 
massage  of,  167,  193 


20 


306 


OENEBAL  INDEX. 


Heat  as  counterirritant,  59,  60 

as  hemostatic,  96 

as  stimulant,  200 
Hemophilia,  57,  109 

calcium  salts  in,  109 
Hemorrhage  after  tooth  extraction,  110 

control  of,  94 

post-partum,  108 
Hemorrhagic  diathesis,  57,  109 
Hemostatic  cotton,  102 
Hemostatics,  40,  94 

coagulant,  96,  100 

mechanical,  110 

vascular,  106 
Heroine,  227,  284 
Hexamethylamina,  149,  284 
Hoffman's  anodyne,  198,  271 
Holocaine  hydrocmoride,  158,  169,  284 
Homatropine,  201,  273 
Honey,  289 
Hot-air  bath,  57 
Hot  mustard  foot-bath,  62 
Howard  method,  168 
Hydragogues,  Plate  XVIII. 
Hydrargyri  chloridum  corrosivum,  142, 
212,  264,  285 
mitis,  212,  285 

iodidum  flavum,  212,  285 

rubrum,  212,  285 
Hydrargyrum,  212,  285 

cum  creta,  212,  285 
Hydrastinine,  35,  285 
Hydrochloride  of   cocaine,  86,    107,  158, 

164,  279 
Hydrocyanic  acid,  207,  218,  262,  270 
Hydrogen  dioxide  (peroxide),  107,  112, 
138,  146,  151,  273 
caustic,  80,  146,  151,  273 
Hydronaphtol,  285 
Hygienic  remedies,  38 
Hyoscine,  201,  264,  285 
Hyoscyamine,  35,  201,  264,  286 
Hyoscyamus,  264,  286 
Hyperisotonic  solution,  52 
Hypnotics,  41,  225 
Hypodermic  method,  45 

dangers  of,  46 

how  to  employ,  47 

'  syringe,  47 

sterilization  of,  47 
use  of,  46 
tablets,  33 
Hypodermoclysis,  49,  200 
Hypoisotonic  solution,  52 
Hypophosphites,  syrups  of,  210,  286 
Hyposulphite  of  sodium,  141,  154,  270 


Ice  and  salt  mixture,  156 
Idiosyncrasy,  53 
Imponderable  remedies,  38 
Incompatibility,  36,  243 

chemical,  244 

intentional,  245 


Incompatibility  of  acids,  244 

of  alcohol,  100 

of  alkalies,  244 

of  alkaloids,  36 

of  alum,  103 

of  antipyrine,  107,  244 

of  benzoic  acid,  129 

of  betanaphtol,  139 

of  borax,  116,  244 

of  boric  acid,  122 

of  calomel,  245 

of  carbohc  acid,  125,  244 

of  chalk,  117 

of  chlorides,  244 

of  chlorine,  136 

of  cocaine  hydrochloride,  168 

of  collodion,  111,  244 

of  glucosides,  244 

of  glycerin,  93,  244 

of  gums,  243 

of  iodine,  66 

of  iron  salts,  102,  244 

of  lead  acetate,  105 

of  lime-water,  116,  245 

of  magnesia,  117 

of  mercuric  chloride,  143,  244,  245 

of  oil  of  turpentine,  63 

of  orthoform,  171 

of  phenol,  125 

of  potassium  chlorate,  139,  244,  245 
iodide,  245 
permanganate,  140,  245 

of  resins,  243 

of  resorcin,  139 

of  salicylic  acid,  130 

of  silver  nitrate,  79,  244,  245 

of  soap,  114 

of  sodium  bicarbonate,  115 
borate,  116 

of  spirit  of  nitrous  ether,  244,  245 

of  sulphur,  245 

of  sulphurous  acid,  153 

of  syrup  of  hypophosphites,  210 

of  tannic  acid,  97,  244,  245 

of  zinc  chloride,  82 
sulphate,  105 

physical,  243 

therapeutic,  245 
Index  of  drugs,  269 
India-rubber,  281 
Indication,  definition  of,  20 
Infusions,  27 

Inhalation,  medication  by,  49 
Inhalers,  181,  185,  187,  189 

Esmarch,  187 
Interstitial  gingivitis,     106.     See    Pyor- 
rhoea alveolaris. 
Intravenous  injection,  49 
Iodide  of  potassium,  213,  215,  264,  293 

rash  from,  215 
Iodides,  213 
Iodine,  63,  136,  212,  264,  286 

caustic,  64 

compound  solution  of,  65,  286 

ointment  of,  66 


GENERAL  INDEX. 


307 


Iodine,  tincture  of,  63,  65,  136,  286 
Churchill's,  64 
decolorized,  66 
with  aconite,  64,  65 
Iodized  phenol,  78 
Iodoform,  137,  286 

substitutes  for,  137 
lodo-glycerole,  106 
lodol,  137,  286 
Ions,  52 

Ipecacuanha,  91,  231,  286 
Iris  fiorentina,  256,  286 
Iron,  208,  282 

action  of,  208 
astringent  salts  of,  101 
dialyzed,  88,  282 

hydrated  oxide  of,  87,  208,  262,  282 
with    magnesia,   208,  262, 
282 
persulphate  of,  102,  282 
Irritants,  59,  261 
Isotonic  solution,  52 

•    of  cocaine,  163 
Itrol,  142,  273 


Jalap,  58,  287,  Plate,  XVIII. 
Juniper,  oil  of,  230,  287 


K. 


Kino,  97,  287 
Krameria,  97,  287 


Labarraque's  solution,  136,  151,  278 

Laborde  method,  168 

Lactic  acid,  73,  270 

Lancing  of  gums,  56,  225 

Lanolin,  91,  271 

Lard,  29,  91,  270 

Latin  in  prescriptions,  250 

declensions,  250 
Laudanum,  265,  290 
Laughing  gas  (nitrous  oxide),  184,  290 
Laxatives,  Plate  XVIII. 
Lead  acetate,  104,  264,  292 

and  opium  wash,  105 

salts,  poisoning  by,  264 

water,  104,  292 
Leech  glass,  56 
Leeching,  56 
Leiter  coil,  96 
Leucomaines,  36,  260 
Leukocytosis,  53 
Licorice  root,  91,  283 
Lime-water,  116,  276 
Liniments,  27 

Linimentum  calcis,  68,  90,  276 
Linseed,  91,  287 

oil,  28,  90 

poultice,  91 
Liquor,  27 

acidi  arsenosi,  211,  273 


Liquor  antisepticus,  122 

arseni  et  hydrargyri  iodidi,  211,  273 

calcis,  116,  276 

chlori  compositus,  136,  278 

ferri  chloridi,  101,  282 

formaldehydi,  148,  283 

iodi  carbolatus,  64 
causticus,  64 
compositus,  65,  286 

sodse  chlorinatse,  136,  151,  278 

sodii  boratis  compositus,  123,  296 
carbolatis,  124,  291 

zinci  chloridi,  81,  300 
Listerine,  138 
Liter,  252 
Lithemia,  118 
Local  analgesics,  155 

remedies,  55 

definitions  of,  39 
Logwood,  97,  284 
Losophane,  137,  288 
Lotio  plumbi  et  opii,  105 
Lugol's  solution,  65,  286 
Lunar  caustic,  78,  273 
Lungs,  medication  by,  49 
Lysol,  138,  288 

M. 

Magnesia,  116,  288 

milk  of,  116 
Magnesium  oxide,  116,  288 

sulphate,  288,  Plate  XVIII. 
Massa,  28 

hydrargyri,  212,  285 
Massage  of  heart,  167,  193 
Materia  medica,  definition  of,  18 
Mechanical  hemostatics,  110 
Medicine,  definition  of,  21 
Medicines,  administration  of,  42 

constituents  of,  22,  34 

modes  of  action  of,  51 

preparations  of,  21,  24 
Mel,  289 

Menthol,  135,  289 
Mercurial  ointment,  212,  285 
Mercurialism,  144 

treatment  of,  144 
Mercury,  22,  212,  285 

bichloride  of,  142,  212,  264,  285 

monochloride  of,  212,  264 

salts,  poisoning  by,  144,  265 

with  chalk,  212,  285 
Meter,  252 
Metric  system,  252 

equivalents  of,  252 
rules  for  use  of,  253,  254 
Mineral  acids,  71,  208 

antidotes  to,  72 
poisoning  by,  72 

astringents,  100 

waters,  118 
Mitigated  caustic,  78,  273 
Mixtures,  28 
Modes  of  action  of  medicines,  51 


308 


GENERAL  INDEX. 


Modes  of  death,  261 
Monsel's  salt,  101,  282 

solution,  102,  282 
Morphine,   35,   87,  226,  265,  289,  Plate 
XVII. 

antagonists  to,  246 

for  chiildren,  226 

habit,  48,  226 
Mouth-washes,  113,  256 

purposes  of,  256 

to  be  antacid,  113 
Mucilages,  28 
Mustard  as  emetic,  61,  230 

as  irritant,  61 

bath,  223 

paper,  62 

plaster,  62 

volatile  oil  of,  29,  61,  135 
My  rosin,  61 
Myrrh,  tincture  of,  128,  289 


N. 

Naphtol,  138,  275 
Narcotic,  41 

habit,  48,  159,  226 
Narcotine,  35 
National  Formulary,  18 
Nerve  blocking  with  cocain,  159 
Neutral  principles,  37 
Nicotine,  267,  289 
Nirvanin,  158,  169,  289 
Nitrate  of  silver,  78,  103,  141,  267,  273 
Nitre,  229,  230,  266,  293 
Nitrite  of  amyl,  203,  265,  272,  Plate  XIII. 

of  sodium,  296,  Plate  XIII. 
Nitrites,  203,  265,  Plate  XIII. 

antagonists  to,  246 
Nitroglycerin,  165,  203,  265,  290,  Plate 

XIII. 
spirit  of,  203,  290 
Nitrous  oxide,  184,  290 

anesthesia,  184 

contraindications  to,  180 

history  of,  173 
Normal  salt  solution,  49,  200 
Nose-bleed,  103,  107 
Nouns,  declensions  of,  250 
Novocaine,  158,  170 
Nuclein,  54,  69 
Nutgall,  97,  283 

Nux  vomica,  202,  206,  265,  290,  Plate 
XI. 


Objects  of  combining  drugs,  239 

Odol,  138 

Official  drugs,  definition  of,  18 

formulas,  definition  of,  238 
Oil,  carron,  68,  90,  276 

castor,  28,  223,  290,  Plate  XVIII. 

cod-fiver,  210,  290 
emulsion  of,  210 

cottonseed,  28,  90,  284 


Oil,  croton,  66,  264,  290,  Plate  XVIII. 

hnseed,  28,  90 

olive,  28,  90,  290 

of  bay,  132 

of  bitter  almond,  29,  272 

of  cajuput,  134,  290 

of  cassia,  132 

of  cinnamon,  132,  279 

of  cloves,  133,  277 

of  eucalyptus,  132,  134,  281 

of  juniper,  230,  287 

of  mustard,  29,  61,  135,  296 

of  peppermint,  132,  135,  200,  289 

of  rose,  256,  294 

of  smoke,  67,  125,  280 

of  theobroma,  31,  298 

of  thyme,  135,  299 

of  turpentine,  62,  135,  200,  230,  267, 
298 
Oils,  distilled,  29,  131 

essential,  29,  131 

fixed,  28 

volatile,  29,  131 

antiseptic  power  of,  132 
Ointments,  33 
Oleate  of  mercury,  212,  285 
Oleates,  28 
Olein,  28 
Oleoresins,  28 
Opium,  22,  225,  265,  290,  Plate  XVII. 

alkaloids  of,  35,  225 

as  hemostatic,  111 

for  children,  226 

haJDit,  48,  226 

poisoning,  265 
Organic  acids,  72 
Orpiment,  262 
Orris  root,  256,  286 
Orthoform,  86,  158,  170,  291 

after  extraction  of  tooth,  171 
Osmosis,  52 
Oxygen  bleaching  agents,  151 


P. 

Palmitin,  28 

Papaver  somniferum,  225,  290 
Papaverine,  35 
Papers,  medicated,  24 
Paregoric,  226,  265,  290 
Paris  green,  262 

Peck,  A.  H.,  experiments  with  antisep- 
tics, 131,  132 
Peppermint,  oil  of,  132,  135,  200,  289 
Pericementitis,  carbolic  acid  in,  76 

counterirritants  in,  61,  62 

hot  mustard  foot-bath  in,  62 

iodine  in,  63 

morphine  in,  226 
Permanganate  of  potassium,  140, 153, 293 
Peroxide  of  hydrogen,  107,  138,  146,  151, 
273 

of  sodium,  152 
Persulphate  of  iron,  102 
Petrolatum,  29,  90,  291 


GENERAL  INDEX. 


309 


Pharmacology,  definition  of,  18 
Pharmacopoeia,  U.  S.,  18,  239 
Pharmacy,  definition  of,  18 
Pharyngitis,  chronic,  103 
Phenacetine,  219,  269 
Phenazone,  106,  272 
Phenol,  74,  123,  126,  262,  291 

germicidal  power  of,  124 

liquefied,  74,  123 

poisoning,  76,  124,  262 

sodique,  124,  291 
Phenolphthalein,  291 
Phenyl  sahcylas,  130 
Phlebotomy,  57 

Phosphoric  acid,  dilute,  210,  270 
Phosphorus,  209,  266,  291 
Physical  action  of  medicines,  51 
Physiologic  action,  19 

antidote,  245 

effect,  19 
Pills   29 
Pilocarpine,  35,  230,  292 

Plumbi  acetas,  104,  264,  292 
Podophyllum,  292,  Plate  XVIII. 
Poisons,  21,  260 

table  of,  262 
Potash,  caustic,  74,  266,  293 
Potassa,  74,  266 
Potassium  acetate,  229,  292 

and    sodium    tartrate,    293,    Plate 
XVIII. 

bitartrate,  52,  229,  266,  292,  Plate 
XVIII. 

bromide,  218,  222,  293,  Plate  XV. 

chlorate,  139,  266,  293 

in  mercurialism,  139,  145 

citrate,  229,  293 

cyanide,  78,  262,  293 

hydroxide,  74,  266,  293 

iodide,  65,  213,  264,  293 
in  mercurialism,  145 

nitrate,  229,  230,  266,^293 

permanganate,  140,  153,  293 
to  remove  stains  of,  140 

sulphate,  266,  293 
Poultice,  91 
Pregnancy,  dentistry  during,  233 

care  of  the  mouth  during,  235 

caries  during,  235 
Preparations  of  drugs,  24 

classes  of,  24 

galenical,  23 
Prepared  chalk,  117,  276 
Prescription,  construction  of,  254 

definition  of,  238 

parts  of,  248 

use  of  Latin  in,  250 

writing,  237 
Prognosis,  definition  of,  20 
Proprietary  solutions,  138 
Protargol,  142,  293 
Proud  flesh,  69,  80 
Prunus  Virginiana,  207,  293 
Ptomaines,  36,  260 


Ptyalagogue,  41 

Pulp,  devitalization  of,  76,  83,  88 

Pulpitis,  63,  76,  217 

Pulse  during  anesthesia,  178,  179 

Pulvis  acetanilidi  compositus,  219 

ipecacuanhse  et  opii,  238 
Pumice,  powdered,  256 
Pupils  during  anesthesia,  178,  179 
Purges,  Plate  XVIII. 
Pyorrhea  alveolaris,  73,  80,  81,  133,  139 
PyrogaUic  acid,  80,  293 
Pyrogallol,  80,  293 
Pyroxylinum,  111,  293 
Pyrozone,  146,  273 

caustic,  80,  152 


Quassia,  205,  294 
Quicksilver,  212,  285 
Quinine,  35,  43,  206,  294 
sulphate,  206,  294 

R. 

Reactionary  effects  of  drugs,  53 
Realgar,  262 

Rectum,  medication  by,  44 
Reducing  agents,  153 
Remedies,  38 

classification  of,  39 

hygienic,  38 

imponderable,  38 

mechanical,  38 

medicinal,  38 

preventive,  38 
Remedy,  definition  of,  21,  38 
Resins,  30 

balsamic,  30 

gum,  30 
Resolution,  20 
Resorcin,  139,  294 
Resorcinol,  139,  294 
Respiration,  artificial,  167,  168,  192 
methods  of,  167,  168 

during  anesthesia,  178,  179 
Restorative  tonics,  207 
Revulsive  action,  60 
Rhatany,  97,  287 
Rhigolene  spray,  156 
Rhubarb,  294,  Plate  XVIII. 
Rochelle  salt,  293,  Plate  XVIII. 
Rose,  oil  of,  256,  294 
Rosin,  62 
Rubefacients,  40,  59 


Saccharine,  256,  275 
Saccharum,  31,  240,  295 

lactis,  32,  295 
SaUcylate  of  phenyl,  130,  291 

of  sodium,  130,  296 
SalicyUc  acid,  129,  258,  270 
Saline  cathartics,  57,  Plate  XVIIL 


310 


GENERAL  INDEX. 


Saline  solution,  49,  200 
Salivation,  144 

treatment  of,  144 
Salol,  130,  291 
Salt  action,  52 

solution,  normal,  49,  200 
Saltpetre,  229,  230,  266,  293 
Santonin,  37,  295 
Sapo,  30,  114,  295 

mollis,  30,  114,  295 
Sarsaparilla,  216,  295 
Scarification,  56 
Sclileich  method,  162 

mixtures,  192 
Scilla,  203,  229,  232,  295 
Scopolamine  hydrobromide,  201,  295 
Sedatives,  41,  217 

for  cliildren,  217,  220 
Seidlitz  poAvder,  293 
Seller's  solution,  138 
Senna,  296,  Plate  XVIII. 
Sensitive  dentine,  76,  81,  117 
Sialagogue,  41,  90 
Silver  citrate,  142,  273 

lactate,  142,  273 

nitrate,  78,  103,  141,  267,  273 
removal  of  stain  of,  78 
to  check  caries,  79 

soluble,  142 
Sinapis,  61,  230,  296 
Sinapism,  62 
Sinigrin,  61 
Skin  grafting,  69 

medication  by,  45 
Slippery  elm,  90,  299 
Soap,  castile,  30,  114,  295 

soft,  30,  114,  295 
Soaps,  30,  114,  295 
Soda,  caustic,  74,  266,  296 
Sodium  bicarbonate,  115,  296 

bisulpliite,  154,  270 

borate,  115,  123,  258,  269 
neutral,  297 

bromide,  218,  296,  Plate  XV. 

chloride,  49,  200,  296 
as  emetic,  231 

diborate,  115,  296 

dioxide,  152,  296 

hydroxide,  74,  296 

hyposulphite,  141,  270 

iodide,  213,  296 

nitrite,  296,  Plate  XIII. 

sahcylate,  130,  296 

silicate,  296 

sozoiodolate,  137 

sulphate,  297,  Plate  XVIII. 

sulphite,  140,  154,  270 

tetraborate,  297 

thiosulphate,  141,  154,  270 
Solubility,  240 
Soluble  glass,  296 
Solutions,  27 

percentage,  241 

table  for  preparing,  243 

saturated,  241 


Solvents,  240 
Somnoform,  190,  192 

deaths  from,  189 
Sozoiodol,  137,  297 
Spanish  flies,  67,  263,  277 
Sparteine,  35,  229,  297 
Specific  disease,  20 

remedy,  20 
Spermaceti,  29,  277 
Spinal  cocainization,  171 
Spirit  of  ammonia,  166,  198,  272 

aromatic,  166,  193,  198,  272 

of  ether,  198,  271 

compound,  198,  271 

of  nitrous  ether,  222,  230,  271 
Spirits,  30 
Spiritus  Eetheris  nitrosi,  222,  230,  271 

frumenti,  98,  271 

vini  galhci,  98,  271 
rectificatus,  193 
Spirocheta  pallida,  216 
Squill,  203,  229,  232,  295 
Standardization  of  drugs,  23 
Stearin,  28 
Sterihzation,  47,  121 
Sternutatory,  41 
Stimulants,  195 

definition  of,  40,  195 

diffusible,  193,  197 

direct,  195 

for  children,  220 

indication  for,  196 

indirect,  196 

irritant,  197 

kinetic,  195 

potential,  195 

reflex,  197 
Stomach  administration,  42 
Stomatitis,  123,  139 
Stovaine,  158,  170 
Stramonium,  267,  297 
Strophanthus,  203,  229,  297 
Strychnine,  165,     193,    202,    265,    297, 
Plates  IV.  and  XI. 

antagonists  to,  246 
Styptic  collodion,  111,  279 
Styptics,  94,  106 
Substitutes  for  cocaine,  169 
Sudorifics,  41 
Suet,  29 
Sugar,  31,  240,  295 

of  lead,  104,  264,  292 

of  milk,  32,  295 
Sulphate  of  copper,  80,  104,  264,  280 

of  zinc,  105,  231,  267,  300 
SulDhonal,  225,  298 
Sulphonethylmethane,  225,  298 
Sulphonmethane,  225,  298 
Sulphur  dioxide,  153 
Sulphurous  acid,  153,  270 
Suppositories,  31 

glycerin,  31 
Sweating  by  hot-air  bath,  57 

by  drugs,  230 
Sweet  spirit  of  nitre,  222,  230,  271 


GENERAL  INDEX. 


311 


Sylvester   method    of   artificial    respira- 
tion, 167 
Symptom,  definition  of,  20 
Syncope,  261 

during  anesthesia,  179 
Synthetics,  22 
Syphihs,  20,  213 

cause  of,  216 

curability  of,  215 

symptoms  of,  215 

treatment  of,  213-215 
Syrups,  31 

of  hypophosphites,  210,  286 

of  iodide  of  iron,  213 

T. 

Table   for   preparing   percentage    solu- 
tions, 243 

of  poisons  and  antidotes,  262 
Tablet  triturates,  33 
Tablets,  compressed,  33 

hypodermic,  33 
Tannic  acid,  36,  96,  244,  245,  270 

glycerite  of,  93 
Tartar  emetic,  231,  272 
Tea,  97 

Terebene,  135,  298 
Thebaine,  35 
Theobroma,  298 

oU  of,  298 
Theobromine,  202,  230,  299 
Therapeutic  effect,  19 
Therapeutics,  definition  of,  18 
Thermocautery,  89 
Tliimble  blister,  68,  188 
Thiosulphate  of  sodium,  141,  154,  270 
Thymol,  135,  299 

iodide,  135,  299 
Thyroid  gland,  109 
Tincture  of  aconite,  64,  65,  222,  262,  270 

of  benzoin,  128,  274 

of  capsicum,  61,  277 

of  chloride  of  iron,  101,  208,  264,  282 

of  myrrh,  128,  289 
Tinctures,  32 
Tobacco,  267,  298 
Tolerance  for  drugs,  19 
Tonics,  40,  204 

bitter,  205 

nutritional,  205 

restorative,  205,  207 
Tooth  paste,  256 

powders,  254 
Toothache,  62,  63,  76,  187 
Toxic  effect  of  a  drug,  19 
Toxicity  of  anesthetics,  190 
Toxicology,  18,  260 
Tricliloracetic  acid,  73,  270 
Trichlorphenol,  125 
Tricresol,  125 
Trional,  225,  298 
Triturates,  32 
Troches,  33 
Tropacocaine  hydrochloride,  158, 169,299 


Turpentine,  oil  of,  62,  135,  200,  230,  267, 
298 
liniment,  27,  62,  298 
stupe,  62 

u. 

Ulmus,  90,  299 
Unguentum,  33 

hydrargyri,  212,  285 
United  States  Pharmacopoeia,  18,  239 
Untoward  effects  of  drugs,  19 
Uric  acid,  118 
Urotropin,  149,  284 
Uva  ursi,  230,  299 

V. 

Vascular  astringents,  106 
Vaseline,  29,  91,  291 
Vegetable  acids,  209 

alteratives,  216 

astringents,  96 
Venesection,  57 
Venom,  260 
Veratrine,  35,  299 
Veratrum,  108,  218,  299 
Vermifuge,  41 
Vesicants,  40,  59 
Vienna  paste,  293 
Vinegars,  24 
Vinum,  34,  299 
Virus,  260 
Vitriol,  blue,  80,  264 

green,  101 

oil  of,  71 

white,  105 
Volatile  oils,  29,  131 

comparative  action  of,  131,  132 

w. 

Warts,  nitric  acid  applied  to,  71 
Waters,  medicated,  24 

mineral,  118 
Wax,  29,  277 
Weeping  gums,  73 
Weights  and  measures,  251 
Whisky,  98,  271 
White  vitriol,  105 
Whooping-cough,  139 
Wild  cherry,  207,  218,  293 
Wine,  red,  34,  299 

white,  34,  299 
Witch-hazel,  97,  284 
Wood  alcohol,  100,  271 

charcoal,  145,  277 

spirit,  100,  271 

blindness  from,  100 


Yeast,  brewers',  69 
Yellow  wash,  285 

Z. 

Zinc  chloride,  81,  105,  141,  267,  300 
iodide,  105,  300 
sulphate,  105,  231,  267,  300 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsi.stxl 

RK  701  L85  1909  C.1 

Dental  materia  medica,  therapeutics  and 


2002403927 


